老年严重创伤患者早期创伤性凝血病的危险因素分析  

Analysis on risk factors for early trauma-induced coagulopathy in the elderly patients with severe trauma

作　　者：周佳圻 胡雨峰 康洋波 沈嘉生 金禹辰 杨琦[1] 许永安[1] Zhou Jiaqi;Hu Yufeng;Kang Yangbo;Shen Jiasheng;Jin Yuchen;Yang Qi;Xu Yongan(Clinical Research Center for Emergency and Critical Care Medicine of Zhejiang Province,Key Laboratory of Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province,Institute of Emergency Medicine of Zhejiang University,Department of Emergency Medicine,Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

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,浙江省严重创伤与烧伤诊治重点实验室,浙江省急危重症临床医学研究中心,杭州310009

出　　处：《中华创伤杂志》2022年第1期61-66,共6页Chinese Journal of Trauma

基　　金：国家自然科学基金(81571916,81372079,81201478);浙江省医药卫生科技计划项目(2013KYA098,2016145610,2020KY577)。

摘　　要：目的探讨老年严重创伤患者早期创伤性凝血病(TIC)的危险因素。方法采用病例对照研究分析2015年2月至2020年11月浙江大学医学院附属第二医院收治的317例老年严重创伤患者的临床资料,其中男212例,女105例;年龄65~96岁[(72.6±6.8)岁]。以国际标准化比值(INR)>1.5为参考标准,分为TIC组(32例)和非TIC组(285例)。比较两组性别、年龄、损伤部位、损伤严重度评分(ISS)、格拉斯哥昏迷评分(GCS)、入院时首次体温及休克指数(SI)、入院时首次血气分析和血常规及凝血功能的化验结果、输血及血制品使用比率、住院时间与临床预后。通过单因素与多因素Logistic回归分析上述指标与早期TIC发生的相关性。结果两组性别、年龄、面部和胸部及腹部损伤、GCS、体温、住院时间差异均无统计学意义(P均>0.05)。两组头颈部及四肢损伤、ISS、SI、pH值、剩余碱(BE)、乳酸、血红蛋白(Hb)、血小板计数(PLT)(首次、最低值)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、血浆纤维蛋白原(FIB)、输血及血制品使用比率、临床预后差异均有统计学意义(P均<0.05)。单因素分析结果显示,头颈部及四肢损伤、ISS、体温、SI、pH值、BE、乳酸、Hb、PLT、APTT、TT、FIB与早期TIC发生有一定的相关性(P均<0.05)。多因素Logistic回归分析结果表明,SI(OR=1.54,95%CI 1.10~2.17,P<0.05)、PLT(OR=0.67,95%CI 0.49~0.91,P<0.05)和FIB(OR=0.56,95%CI 0.40~0.78,P<0.01)与TIC显著相关。结论高SI值、低PLT和低FIB水平是早期TIC发生的独立危险因素。Objective To explore the risk factors for early trauma-induced coagulopathy(TIC)following severe trauma in the elderly patients.Methods A case-control study was used to analyze the clinical data of 317 elderly patients with severe trauma admitted to Second Affiliated Hospital of Zhejiang University School of Medicine between February 2015 and November 2020.There were 212 males and 105 females,aged 65-96 years[(72.6±6.8)years].The patients were divided into TIC group(n=32)and non-TIC group(n=285)using the international normalised ratio(INR)>1.5 as the reference standard.Sex,age,trauma sites,injury severity score(ISS),Glasgow coma scale(GCS),first body temperature on admission,shock index(SI),first laboratory results of arterial blood gas,routine blood and coagulation,blood transfusion,usage of blood product,hospitalization days and clinical outcomes were compared between the two groups.Univariate and multivariate Logistic regression analysis were used to identify the risk factors for early TIC in patients with severe trauma.Results Differences in sex,age,injuries to the face,chest and abdomen,GCS,first body temperature and hospitalization days were not statistically significant between the two groups(all P>0.05).The two groups showed statistical differences in the ratio of injuries to head,neck and extremities,ISS,SI,pH value,base excess(BE),lactate,hemoglobin(Hb),platelet(PLT)count(first detection,lowest level),activated partial thromboplastin time(APTT),thrombin time(TT),plasma fibrinogen(FIB),blood transfusion and usage of blood product and clinical outcomes(all P<0.05).According to the univariate analysis,injuries to the head,neck and extremities,ISS,first body temperature,SI,pH value,BE,lactate,Hb,PLT,APTT,TT and FIB were correlated with the occurrence of early TIC(all P<0.05).Multiple Logistic regressions analysis showed that SI(OR=1.54,95%CI 1.10-2.17,P<0.05),PLT(OR=0.67,95%CI 0.49-0.91,P<0.05)and FIB(OR=0.56,95%CI 0.40-0.78,P<0.01)were significantly correlated with the occurrence of early TIC.Conclusion F

关 键 词：创伤和损伤 血液凝固障碍 老年 危险因素 

分 类 号：R641[医药卫生—外科学]