ICU中创伤性凝血病的影响因素与临床意义  

Risk factors and clinical effects of trauma induced coagulopathy in ICU patients with major trauma

作　　者：徐善祥[1] 王连[1] 杨俭新[1] 周光居[1] 张茂[1] 

机构地区：[1]浙江大学医学院附属第二医院急诊医学科浙江大学急救医学研究所,杭州310009

出　　处：《中华急诊医学杂志》2012年第9期1007-1011,共5页Chinese Journal of Emergency Medicine

摘　　要：目的探讨重症监护病房（ICU）中创伤性凝血病的影响因素及对严重创伤患者预后的影响。方法回顾性收集2008年6月至2009年9月伤后24h内收住浙江大学医学院附属第二医院院急诊ICU的223例严重创伤患者的资料，记录损伤严重程度评分（ISS）、急性生理和慢性健康评分（APACHEII）、收住时的凝血功能、血常规、生化常规和血气分析等指标。以需要血管活性药物维持血压、碱缺失（BD）I〉6和休克指数（SI）≥1作为存在组织低灌注的标准。根据凝血功能结果将患者分为凝皿病组和无凝血病组（对照组）。比较两组间创伤严重程度、APACHEⅡ值、低体温及低灌注发生率等指标，分析创伤性凝血病的影响因素，并建立多因素回归方程。比较死亡与存活患者凝血功能指标及创伤性凝血病的发生率。结果52例（23．3％）符合创伤性凝血病的诊断，病死率明显高于对照组（36．5％vb9．4％，P〈0．01）。两组间的年龄、性别构成、创伤原因和受伤时间具有可比性，凝血病组的损伤严重程度评分、低体温和组织低灌注发生率、合并严重脑损伤的比例明显高于对照组（P《0．01），GCS评分、血红蛋白浓度（Hb）、红细胞压积（Hct）和血小板（Pit）计数均明显低于对照组（P〈0．01）。多因素logistic回归分析显示BD≥6、GCS≤8和Plt计数是创伤患者入ICU时发生凝血病的独立预测因素。与存活患者相比，死亡患者的凝血功能指标明显延长。结论伤盾24h内收住ICU的创伤患者有较高的创伤性凝血病发生率；创伤性凝血病与全身损伤严重程度、合并重型颅脑损伤、休克及低体温有关，并对不良预后有重要影响。Objective To investigate the risk factors of trauma induced coagulopathy and its effect on the outcome of ICU patients with severe trauma. Methods Totally 223 severe trauma patients admitted to emergency ICU within 24h after injuring between June, 2008 and September, 2009 were retrospectively analyzed, Injury severity score （ISS）, APACHE Ⅱ score, coagulation function, routine blood test, biochemical test, and blood gas assay were completed for each patient. Hypoperfusion was defined as vasoactive agents usage, or base deficit （BD） ≥ 6 or shock index ≥ 1. Patients were divided into coagulopathy group and non-coagulopathy （control） group according to coagulation function. ISS, APACHE Ⅱ score, the occurrence of hypothermia and hypoperfusion were compared between the two groups. The risk factors of trauma induced coagulopathy were analyzed, and the multivariate logistic regression equation was formulated. Coagulation function and incidence of trauma induced coagulopathy were compared between non- survival and survival group. Results Fifty-two of 223 （23.3 % ） patients met the criteria of trauma inducedcoagulopathy. Mortality rate in this group was significantly higher than that in non-coagulopathy group （36. 5% vs 9.4%, P 〈 0. 01 ）. Patients in both groups had the comparability in age, sex, injury mechanism and time after trauma. ISS, the incidence of hypothermia, hypoperfusion and severe traumatic brain injury in coagulopathy group were higher than those in non-coagulopathy group （P 〈 0. 01 ）. GCS, hemoglobin, hematocrit, and platelet counts in coagulopathy group were significantly lower than that in non- coagulopathy group （P 〈 0. O1 ）. Base deficit ≥6, GCS ≤8, and plateiet counts were considered as the independent risk factors involved in trauma- induced coagulopathy according to logistic regression in this study. Coagulation function of non-survivors also remarkably attenuated when compared with survival group. Conclusions The incidence rate of trauma induced coagulop

关 键 词：严重创伤 创伤性凝血病 危险因素 预后 

分 类 号：R641[医药卫生—外科学]