接受手术治疗的脾破裂患者创伤性凝血病的危险因素分析  

Risk factors for trauma-induced coagulopathy in patients with splenic rupture following sur-gical management

作　　者：余浩 李贺[1] 尹纯林[1] 高明[1] Yu Hao;Li He;Yin Chunlin;Gao Ming(Department of Emergency Surgery,the Second Affiliated Hospital of Anhui Medical University,Hefei230000,China)

机构地区：[1]安徽医科大学第二附属医院急诊外科,合肥230000

出　　处：《创伤外科杂志》2024年第2期110-114,共5页Journal of Traumatic Surgery

摘　　要：目的探讨接受手术治疗的脾破裂患者创伤性凝血病(TIC)的危险因素。方法回顾性分析2017年1月—2021年12月安徽医科大学第二附属医院急诊外科治疗因创伤致脾破裂行手术治疗患者84例,男性52例,女性32例;年龄18~82岁,平均50.1岁;道路交通伤37例,高处坠落伤21例,跌倒伤15例,殴打伤11例。根据是否合并TIC分为TIC组(30例)和非TIC组(54例)。对两组患者性别、年龄、受伤时间、休克指数、入院时首次体温、ISS、入院时首次血红蛋白、红细胞比容、血小板计数、CRP、肝功能(谷丙转氨酶)、营养状况(白蛋白)、pH值、剩余碱(BE)、乳酸、INR、D-二聚体、APTT、TT、血浆纤维蛋白原(FIB)、出血量行单因素分析,取其中有统计学意义的变量做多因素Logistic回归分析。判断影响接受手术治疗的脾破裂患者创伤性凝血病的的危险因素。结果两组患者年龄、血红蛋白、红细胞比容、D-二聚体、失血量、入院时首次体温、CRP、谷丙转氨酶、白蛋白比较差异无统计学意义(P>0.05);而休克指数、血小板计数、受伤时间、ISS、pH值、BE、乳酸、APTT、TT、FIB比较差异有统计学意义(P<0.05)。多因素回归分析发现休克指数(OR=2.355,95%CI 1.318~3.948,P<0.05)、血小板计数(OR=0.987,95%CI 0.970~1.004,P<0.05)、FIB(OR=0.599,95%CI 0.180~0.972,P<0.05)与创伤性凝血病显著相关。结论休克指数、血小板计数、FIB是接受手术治疗的脾破裂患者发生创伤性凝血病的独立危险因素。Objective To explore the risk factors of trauma-induced coagulopathy(TIC)in patients with splenic rupture following surgical treatment.Methods A retrospective analysis was conducted on 84 patients who underwent surgical treatment for traumatic splenic rupture in the emergency department of the Second Affiliated Hospital of Anhui Medical University from Jan.2017 to Dec.2021,including 52 males and 32 females aged 18-82 years,with the average age of 50.1 years.There were 37 cases of road traffic injuries,21 falls from height,15 ground-level falls,and 11 assault injuries.Patients were divided into TIC group(n=30)and non-TIC group(n=54)based on whether they were combined with TIC.For both groups,gender,age,injury time,shock index,initial temperature on admission,ISS,and first test results after admission for hemoglobin,hematocrit,platelet count,C-reactive protein(CRP),liver function(alanine aminotransferase),nutritional status(albumin),pH value,base excess(BE),lactate,international normalized ratio,D-D dimer,activated partial thromboplastin time(APTT),thrombin time(TT),plasma fibrinogen(FIB),and blood loss were analyzed using the univariate analysis.The variables showing statistically significant difference were selected for multivariate logistic regression analysis.Results The variables of age,hemoglobin,hematocrit,D-D dimer,blood loss,initial temperature CRP,alanine aminotransferase and albumin on admission revealed no significant difference(all P>0.05),whereas the shock index,platelet count,injury time,ISS,pH value,BE,lactate,APTT,TT,FIB showed statistically significant differences between the two groups(all P<0.05).Multivariate regression analysis further revealed that shock index(OR=2.355,95%CI 1.318-3.948),platelet count(OR=0.987,95%CI 0.970-1.004),and FIB(OR=0.599,95%CI 0.180-0.972)were significantly correlated with the incidence of TIC(all P<0.05).Conclusion For trauma patients with splen-ic rupture,the shock index,platelet count,and FIB are independent risk factors for developing DIC after surgical mana gemen

关 键 词：脾破裂 创伤性凝血病 危险因素 休克指数 血小板计数 

分 类 号：R641[医药卫生—外科学]