多发伤合并腹部脏器损伤血清凝血功能指标、CK及PCT水平及其对预后的影响  

Serum coagulation function indexes,CK and PCT levels in patients with multiple trauma complicated with abdominal visceral injury and the effect on prognosis

作　　者：刘明双 徐勇 丰文学 蒋林祝 胥艳 LIU Mingshuang;XU Yong;FENG Wenxue;JIANG Linzhu;XU Yan(Department of Emergency,Chengdu 363 Hospital,Chengdu 610041;Department of Endocrinology,Affiliated Hospital of Southwest Medical University,Luzhou Sichuan 646000,China)

机构地区：[1]成都三六三医院急诊科,成都610041 [2]西南医科大学附属医院内分泌科,四川泸州646000

出　　处：《临床与病理杂志》2020年第6期1477-1482,共6页Journal of Clinical and Pathological Research

摘　　要：目的:观察多发伤合并腹部脏器损伤患者血清凝血指标、肌酸激酶(creatine kinase,CK)、降钙素原(procalcitonin,PCT)水平,并分析多发伤合并腹部脏器损伤预后的影响因素。方法:收集2014年1月至2019年8月收治的124例多发伤患者。按是否合并腹部脏器官损伤分为合并组(n=71)与非合并组(n=53),比较两组血清凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、血小板计数(platelet count,PLT)、纤维蛋白原(fibrinogen,FIB)、CK及PCT水平的差异。合并组按照入院30 d预后分为生存组与死亡组,比较两组上述指标的差异,并进行单因素及多因素logistic回归分析筛选影响多发伤合并腹部脏器损伤预后的因素。结果:合并组PT,APTT,FIB,CK,PCT及创伤严重程度评分(Injury Severity Score,ISS)高于未合并组(P<0.05),PLT低于未合并组(P<0.05);合并组患者院内30 d死亡36例(50.70%),死亡组血压<60 mmHg、创伤至入院时间≥6 h、ISS>25、GCS<10所占比例及PT,APTT,FIB,CK,PCT,ISS高于存活组,PLT低于存活组(P<0.05);创伤至入院时间,ISS,GCS评分,PT,APTT,FIB,PLT,CK,PCT均为影响多发伤合并腹部脏器官损伤患者预后危险因素(P<0.05),收缩压和PLT为保护因素。结论:多发伤合并腹部脏器损伤伴明显凝血功能紊乱,CK和PLT水平上升,且上述因子均为影响患者预后的因素。Objective:To analyze features of serum coagulation indexes,creatine kinase(CK)and procalcitonin(PCT)of patients with multiple trauma complicated with abdominal visceral injury,and summarize influencing factors of prognosis.Methods:A total of 124 patients with multiple trauma admitted between January 2014 and August2019 were selected.They were divided into a complication group(n=71)and a non-complication group(n=53)according to whether they had abdominal visceral injury.The levels of serum prothrombin time(PT),activated partial thromboplastin time(APTT),platelet count(PLT),fibrinogen(FIB),CK and PCT were compared between the two groups.Patients in the complication groups were divided into the survival group and the death group according to the 30-day prognosis,and above indicators were compared between the two groups.Univariate and multivariate Logistic regression analysis were applied to screen influencing factors of prognosis in multiple trauma complicated with abdominal visceral injury.Results:PT,APTT,FIB,CK,PCT and Injury Severity Score(ISS)in the complication group were higher than those in non-complication group(P<0.05),while PLT was lower than that in non-complication group(P<0.05).There were 36 patients in complication group died in the hospital within 30 days,and the mortality rate was 50.70%.The proportions of blood pressure<60 mmHg,time from trauma to admission≥6 h,ISS>25 points and GCS score<10 points,PT,APTT,FIB,CK,PCT and ISS in the death group were higher than those in the survival group,while PLT was lower than the survival group(P<0.05).The time from trauma to admission,ISS,GCS score,PT,APTT,FIB,PLT,CK and PCT were prognostic risk factors for patients with multiple trauma and abdominal visceral injury(P<0.05).Systolic blood pressure and PLT were protective factors.Conclusion:There is obvious coagulopathy in patients with multiple trauma complicated with abdominal visceral injury.The concentrations of CK and PLT increase,and these factors are related factors affecting the prognosis of patients.

关 键 词：多发伤 脏器损伤 凝血功能 肌酸激酶 降钙素原 预后 

分 类 号：R73[医药卫生—肿瘤]