早期人纤维蛋白原治疗创伤性凝血病的临床研究  

Clinical study on early treatment of trauma-induced coagulopathy with human fibrinogen

作　　者：周黎琴 马欢杰 周敏锋 楼大勇 赵金凯 边蓉 张叶飞 ZHOU Liqin;MA Huanjie;ZHOU Minfeng;LOU Dayong;ZHAO Jinkai;BIAN Rong;ZHANG Yefei(Department of Pharmaceutical Affairs,Zhuji People′s Hospital in Zhejiang Province,Zhuji 311800,China;Department of Emergency,Zhuji People′s Hospital in Zhejiang Province,Zhuji 311800,China)

机构地区：[1]浙江省诸暨市人民医院药事部,浙江诸暨311800 [2]浙江省诸暨市人民医院急诊科,浙江诸暨311800

出　　处：《中国现代医生》2022年第3期24-27,共4页China Modern Doctor

基　　金：浙江省基础公益研究计划项目(LGF20H030001);浙江省医学会临床科研基金项目(2017ZYC-A96)。

摘　　要：目的探讨早期给予人纤维蛋白原对创伤性凝血病患者的临床疗效及相关因素影响。方法选取2017年10月至2018年10月诸暨市人民医院收治的167例严重创伤患者作为研究对象,根据TIC诊断标准最终选择符合条件的80例凝血病患者,将其分为对照组和试验组,每组各40例,其中对照组按照常规TIC治疗指南进行治疗,试验组在对照组的基础上,入院后60 min内给予人纤维蛋白原,通过比较两组凝血指标、血制品用量及评估安全性指标,观察早期给予人纤维蛋白原对创伤性凝血病患者的临床疗效。结果对照组和试验组患者首次输血的中位时间分别为115 min,85 min。与治疗前比较,试验组和对照组在治疗后PT、APTT均明显降低,而FIB、Hb、PLT水平均显著升高,差异有统计学意义(P<0.05),经治疗后4、8、12和24 h,试验组患者的FIB水平均显著高于对照组。试验组患者的FFP、RBC用量均明显比对照组少,差异有统计学意义(P<0.05),两组总住院时间有明显差异(P<0.05)。结论人纤维蛋白原在抗纤溶、止血方面效果显著,早期给予人纤维蛋白原可及时有效地补充凝血因子的丢失,缓解应激反应,在一定程度上减少血制品用量,改善患者预后,具有较高的临床应用价值。Objective To investigate the clinical efficacy of early administration of human fibrinogen on patients with trauma-induced coagulopathy(TIC)and the influence of related factors.Methods A total of 167 severe trauma patients admitted to Zhuji People′s Hospital from October 2017 to October 2018 were included in this study.According to the TIC diagnostic criteria,80 eligible coagulopathy patients were finally selected and divided into the control group and the experimental group with 40 cases each.The control group was treated in accordance with the conventional TIC treatment guidelines,while the experimental group was treated with human fibrinogen within 60 minutes after admission on the basis of the same treatment as the control group.The coagulation index,blood product dosage and safety evaluation indicator were compared between the control group and the experimental group.The clinical efficacy of early administration of human fibrinogen on TIC patients was observed.Results The median times for the first blood transfusion in the control group and the experimental group were 115 minutes and 85 minutes,respectively.Compared with those before treatment,the prothrombin time(PT)and activated partial thromboplastin time(APTT)of the experimental group and the control group after treatment significantly decreased,while the levels of fibrinogen(FIB),hemoglobin(Hb),and blood platelet(PLT)significantly increased,with statistically significant differences(P<0.05).The FIB levels of the experimental group at 4 h,8 h,12 h and 24 h after treatment were significantly higher than those of the control group.The dosage of fresh frozen plasma(FFP)and dosage of red blood cell(RBC)in the experimental group were significantly less than those in the control group,with statistically significant differences(P<0.05).There was significant difference in the total length of stay between the two groups(P<0.05).Conclusion Human fibrinogen exerts significant effects on anti-fibrinolysis and hemostasis.Early administration of human fibrinogen can

关 键 词：创伤性凝血病 创伤 凝血障碍 纤维蛋白原 

分 类 号：R641[医药卫生—外科学]