轻中度肋骨骨折患者创伤早期凝血功能的变化  

Changes of coagulation function in early stage among rib fracture patients with mild to moderate injury severity score

作　　者：余守强 全勇辉 孙宝林 YU Shouqiang;QUAN Yonghui;SUN Baolin(Department of Thoracic Surgery,Nanjing Lishui People's Hospital,Nanjing 211200,Jiangsu,China)

机构地区：[1]南京市溧水区人民医院胸外科,江苏南京211200

出　　处：《检验医学》2018年第3期213-215,共3页Laboratory Medicine

摘　　要：目的探讨轻中度肋骨骨折患者创伤早期的凝血功能变化。方法回顾分析住院治疗的、创伤评分为轻中度且以肋骨骨折为第一诊断的95例患者的凝血功能。采用凝固法-比色法检测凝血功能,同时收集患者的临床资料。结果 95例轻中度肋骨骨折患者胸部创伤简化损伤分级(AIS)为1~4级,中位数(M)为3级;创伤严重度评分(ISS)为2~41分,M为11分;纤维蛋白原降解产物、纤维蛋白原、凝血酶时间、D-二聚体水平分别为6.80(4.10~17.30)mg/L、(4.23±0.45)g/L、(19.45±1.30)s、1 560.00(757.00~4 732.00)μg/L,均明显高于各自的参考值(P<0.05),而抗凝血酶Ⅲ、国际标准化比值、活化部分凝血活酶时间(APTT)分别为(87.30±14.15)%、0.97±0.08、(29.12±4.28)s,均低于各自的参考值(P<0.05);凝血酶原和凝血酶原时间(PT)活动度分别为(11.17±0.89)s、(107.91±16.76)%,与各自的参考值比较差异均无统计学意义(P>0.05)。相关性分析显示ISS与纤维蛋白原降解产物和D-二聚体水平均呈等级相关(rs值分别为0.283、0.308,P<0.05),AIS与纤维蛋白原降解产物、D-二聚体水平均呈等级相关(rs值分别为0.224、0.226,P<0.05)。结论凝血功能在以肋骨骨折为第一诊断的轻中度创伤患者中早期即发生明显变化,主要表现为纤溶亢进和高凝状态,纤溶亢进与创伤的严重程度相关。Objective To investigate the changes of coagulation function in early stage among rib fracture patients with mild to moderate injury severity score(ISS).Methods The changes of coagulation function in early stage among 95 rib fracture patients with mild to moderate ISS were analyzed retrospectively.The coagulation function was determined by coagulation-colorimetry method.The clinical data were collected.Results The medians(M)of abbreviated injury scale(AIS)and ISS were 3(1-4)and 11(2-41),respectively.The levels of fibrinogen degradation product,fibrinogen,thrombin time and D-dimer were 6.80(4.10-17.30)mg/L,(4.23±0.45)g/L,(19.45±1.30)s and 1 560.00(757.00-4 732.00)μg/L,which were higher than their reference values(P<0.05).The levels of antithrombinⅢ,international normalized ratio and activated partial thromboplastin time(APTT)were(87.30±14.15)%,0.97±0.08 and(29.12±4.28)s,which were lower than their reference values(P<0.05).The levels of prothrombin and prothrombin time(PT)activity were(11.17±0.89)s and(107.91±16.76)%,with no statistical significance compared with their reference values(P>0.05).Correlation analysis showed that ISS was rank correlated with fibrinogen degradation product and D-dimer(rs=0.283 and 0.308)(P<0.05).AIS was rank correlated with fibrinogen degradation product and D-dimer(rs=0.224 and 0.226)(P<0.05).Conclusions The coagulation function in early stage among rib fracture patients with mild to moderate ISS is changed obviously,mainly in high-level fibrinolytic function and coagulation state,and high-level fibrinolytic function is related to the severity of trauma.

关 键 词：凝血功能 肋骨骨折 轻中度创伤 创伤早期 

分 类 号：R446.1[医药卫生—诊断学]