西宁地区严重创伤后早期并发弥漫性血管内凝血的诊治  

Diagnosis and Treatment of Early DIC after Severe Trauma at High Altitude

作　　者：马四清[1] 吴新民[1] 杨正平[1] 叶成杰[1] 赵琳[1] 石青军[1] 

机构地区：[1]青海省人民医院,810007

出　　处：《高原医学杂志》2009年第1期10-13,共4页Journal of High Altitude Medicine

基　　金：青海省科技厅资助项目(No.05-N-122)

摘　　要：目的:探讨西宁地区严重创伤患者发生弥漫性血管内凝血(DIC)特点,并提出相应的治疗方法。方法:分析20例DIC患者的实验室指标:包括凝血酶原时间(PT)、白陶土部分凝血酶原时间(KPTT)、凝血酶时间(TT)、纤维蛋白原(FBG)、D-Dimer试验(D-D)和血小板(PLT)计数和临床表现,并进行急性生理与慢性健康指标(APACHEⅡ)评分,脏器衰竭数目评定,提出治疗对策。治疗原发病,支持脏器功能,补充凝血因子,早期使用小分子肝素是治疗的关键。结果:20例DIC中,成活14例,死亡6例。20例患者在第一天均出现DIC指标的异常,每个病人脏器衰竭的数目都在2个以上,两组差别两者无统计学意义(P>0.05);成活组APACHEⅡ评分为(26.1±8.48)分,死亡组为(26.5±8.56)分,两组差别两者无统计学意义(P>0.05);20例病人经过治疗7天后,死亡组患者DIC指标明显恶化,6例患者均出现PLT明显下降,D-Dimer明显升高,同时FBG明显降低,PT、APTT继续延长,而成活组仅有5例上述指标异常,两组比较差别两者有统计学意义(P<0.01),同时,成活组APACHEⅡ评分下降为(17.6±5.7)分,而死亡组为(28.6±6.1)分,两组比较差别两者有统计学意义(P<0.01);死亡组器官衰竭数目均达到4个以上,而成活组存在3个器官衰竭的仅5例,两组比较差别两者有统计学意义(P<0.05)。结论:严重创伤患者易并发DIC,尤其在高海拔地区,积极治疗原发病,加强受损器官的监测与支持,并及时应用低分子肝素,会明显提高抢救成活率。Objective： To estimate the feature of diagnosis and treatment for early disseminated intravascular coagulation （DIC） after severe traumas with at high altitude. Methods： The laboratory indices including prothrombin time（PT）, activated partial thromboplastin time（APTT）, thrombin time （TT）, fibrinogen （FBG）, D--Dimer （D--D）, and platelet（PLT） were measured and assessed for 20 patients with DIC. And acute physiological, chronic health evaluation Ⅱ （APACHE Ⅱ） and numbers of failure organ were conducted with an available treatment. Results.All 20 patients had abnormal indices of DIC on first day after severe trauma and over two failure organs. 14 of 20 cases were survived （survival group） and 6 died （death group）. There is no difference between both group for APACHE Ⅱ and numbers of failure organ （P〉0. 05）. After day 7 treatment, level of PLT and FBG decreased greatly, D--D, PT,APTT increased significantly in death group; 5 cases of survival group had only abnormal PLT.D-D.FBG,PT,APTT, and there is a significant difference between two groups （P〈0. 05）. Moreover, APACHEⅡ decreased to 17.6 ±5.7 in survival group and 28. 6±6. 1 in death group （P〈0. 01） ; more 4 organs occurred failure in the death group but 3 failure organs in 5 cases of survival group （P〈0. 05）. Condusions： Severe traumas are ease to be complicated with DIC at high altitude. Treatment of primary disease, in support of organ function, added coagulation factor, early use of small molecule heparin are active and key way for patients with severe trauma complicated with DIC.

关 键 词：弥漫性血管内凝血 创伤 诊治 西宁地区 

分 类 号：R641[医药卫生—外科学] R554.8[医药卫生—临床医学]