高原地区严重创伤后多脏器功能不全患者凝血功能的变化及意义  

Changes of Coagulation Function and its Significance in Patients with Multiple Organ Dysfunction Syndromes(MODS)after Serious Trauma at High Altitude

作　　者：钱惠岗[1] 公保才旦[1] 樊建林[1] 陈光安[1] 卓么加[1] 

机构地区：[1]青海省人民医院急救中心外科,810007

出　　处：《高原医学杂志》2011年第3期1-4,共4页Journal of High Altitude Medicine

摘　　要：目的:分析高海拔地区严重创伤后多脏器功能不全患者凝血功能的变化,及其对病情严重度和预后的判断价值。方法:回顾分析了我院急救中心2006年7月—2011年6月收治的来自海拔2 260m～4 000m的青海省内168例严重创伤患者(NISS≥20),按有无并发多脏器功能不全综合征(MODS)分为MODS组和非MODS组;分为生存组和死亡组;按各凝血指标分为正常组和异常组。测定血浆凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、D-二聚体(D-Dimer)、纤维蛋白(原)降解产物(FDP)及血小板(PLT),同时记录患者的创伤评分(NISS)。结果:MODS组FDP、D-Dimer明显高于非MODS组,PLT明显低于非MODS组,PT、APTT明显较非MODS组延长。死亡组D-Di-mer明显高于生存组,PLT明显低于生存组,APTT、PT明显较生存组延长。凝血相关指标异常组NISS明显高于正常组。结论:高海拔地区严重创伤患者凝血功能出现显著异常,其中PT、APTT、D-Di-mer、FDP及PLT对病情严重度及预后有一定的价值。Objective：To investigate the relationship between coagulation dysfunction and severity and prognosis of patients after serious traumatic at high altitude.Methods：The documents of 168 patients with serious trauma（NISS≥20）from different geographic altitude（2 260m^4 000m） in Qinghai area were reviewed in our hospital from July 2006 to June 2011.They were divided into three groups： the multiple organ dysfunction syndrome（MODS） vs.non-MODS,and the survival vs.death,or the normal and abnormal group according to the blood coagulation index,such as platelets and the four coagulation indices measured,and NISS scores were determined at the admission day.Results：The level of platelet was lower,furthermore the level of D-Dimer,fibrin degradation product（FDP） were dramatically higher in MODS and death cases than those in non-MODS and survival patients respectively,as well prothrombin time（PT） and active partial thromboplastin time（APTT） were obviously prolonged in MODS patients.And APTT、PT were obvious prolonged in death cases.NISS scores were significantly higher in patients with abnormal coagulation indices as compared with patients with normal indices.Conclusions：The coagulation dysfunction of serious traumatic patients is associated with the severity and prognosis of the illness at high altitude.

关 键 词：高原地区 创伤 多脏器功能不全 凝血 

分 类 号：R641[医药卫生—外科学] R339.5[医药卫生—临床医学]