人重症胸腹损伤所致急性凝血功能障碍相关因素的分析  

The factors cause acute coaguiopathy after severe chest-abdomen injury

作　　者：李志伟[1] 王著军 徐旭[1] 乔帅[1] 梁永刚[1] 周志军[1] 边慧娟[1] 

机构地区：[1]中国人民解放军第二五三医院急诊科,内蒙古呼和浩特010051 [2]呼和浩特国际机场集团有限公司急救中心,内蒙古呼和浩特010070

出　　处：《基础医学与临床》2014年第8期1076-1078,共3页Basic and Clinical Medicine

摘　　要：目的探讨肿瘤坏死因子-α(TNF-α)、内毒素(LPS)、磷脂酶A2(PLA2)和血小板活化因子(PAF)与重症胸腹损伤凝血功能障碍的相关性。方法收集2009年1月至2012年6月在解放军第253医院就诊,创伤指数≥17分,除外合并颅脑损伤及急诊死亡的胸腹损伤患者82例,在救治同时检查血小板计数(PLT)、血浆D-二聚体(D-D)、凝血酶时间(TT)、TNF-α、LPS、PLA2和PAF,对结果进行相关性检验。结果 PLT:83.4±38.5(109/L),D-D:1 824±608(U/L),TT:58.3±12.4(s);TNF-α:36.4±18.1(ng/m L),LPS:344±106(IU/L),PLA2:41.4±14.3(ng/m L),PAF:15 765±4 432(ng/L)。PLT与TNF-α、LPS、PLA2、PAF之间相关系数(r)均小于-0.881,显著负相关,D-D、TT与TNF-α、LPS、PLA2、PAF之间r均大于0.917,显著正相关。结论 TNF-α、LPS、PLA2、PAF可能参与了胸腹损伤凝血功能障碍的发生。对TNF-α、LPS、PLA2、PAF早期干预,或可改善伤者的凝血功能,提高生存率。Objective To investigate the correlation among tumor necrosis factor-α （LPS）, phospholipase A2 （PLA2）, platelet activating factor （PAF） and the blood c （ TNF-α）, lipopolysaccharide oagulation function disorder in severe chest-abdominal injury and to study the effect of these factors on it. Methods Totally 82 subjects with severe chest-abdominal injury were collected in the 253th Hospital of PLA from January 2009 to June, 2012, of whom the trauma index were all higher than or equal to 17 points, and as the rescue and treatment were in progress the patients were examined platelet count （ PLT）, D-dimer （ D-D ）, thromboplastin time （TT）, TNF-α, LPS, PLA2 and PAF for correlation analysis. Results PLT：83.4±38.5（109/L） ,D-D：1824 ±608（U/L） ,TT：58.3 ± 12. 4（s） TNF-α ：36. 4 ± 18. 1 （ng/mL） ;LPS ：344± 106（IU/L） ;PLA2：41.4 ±14. 3 （ng/mL） ;PAF： 15 765 ± 4 432 （ng/L） were related to the blood coagulation function with injury factors. Conclusions TNF-α, LPS, PLA2 and PAF all participate in the process of the blood coagulation function disorder in severe chest-abdominal injury. The prophase interference to TNF-α, LPS, PLA2 and PAF is possible to improve the coagulation dysfunction in severe chest-abdomi- nal injury.

关 键 词：重症胸腹损伤 凝血功能紊乱 肿瘤坏死因子 内毒素 磷脂酶A2 血小板活化因子 

分 类 号：R641[医药卫生—外科学]