349例创伤性凝血病患者凝血酶原复合物疗效及预后分析  

Efficacy and prognostic analysis of prothrombin complex concentrate in 349 patients with trauma-induced coagulopathy

作　　者：麻贤辉 康洋波 杨琦[1] 丁洪波 沈嘉生 许永安[1] Ma Xianhui;Kang Yangbo;Yang Qi;Ding Hongbo;Shen Jiasheng;Xu Yong'an(Department of Emergency Medicine,The Second Affiliated Hospital,Zhejiang University School of Medicine,Key Laboratory of Severe Burn and Trauma Treatment and Emergency Rescue in Zhejiang Province,Zhejiang Province Clinical Research Center for Critical Illness,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、全省严重烧创伤诊治与应急救援重点实验室、浙江省急危重症临床医学研究中心,杭州310009

出　　处：《中华急诊医学杂志》2025年第1期70-77,共8页Chinese Journal of Emergency Medicine

基　　金：浙江省科技厅“尖兵领雁+X”研发攻关计划(2024C03186);国家中医药管理局应急司-浙江省共建重大项目(GZY-ZJ-KJ-24030)。

摘　　要：目的创伤性凝血病(trauma-induced coagulopathy,TIC)患者使用凝血酶原复合物(prothrombin complex concentrate,PCC)的疗效及TIC患者的预后因素分析。方法采用回顾性研究分析2021年1月至12月期间11家医院收治的TIC患者的临床资料,包括基本信息、伤情特征、血制品治疗(含PCC)、入院及24 h后检验指标,治疗措施及临床预后情况(出院好转、住院时间)等。根据TIC患者是否使用PCC治疗分为常规组和PCC组,并利用倾向性匹配方法按照1:1匹配,比较不同指标的组间差异。采用单因素及多因素Logistic回归分析、ROC曲线分析TIC患者预后的影响因素。结果349例TIC患者经倾向性匹配后筛选出PCC组及常规组各103例。单因素分析发现,PCC组与常规组之间年龄、性别、格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)、损伤严重度评分、急性生理学与慢性健康状况评分、基础疾病、院前时间、损伤类型与部位、治疗措施(血管活性药物、钙剂、氨甲环酸使用以及急诊手术)之间差异均无统计学意义(均P>0.05)。与常规组相比,PCC组24 h白细胞计数、乳酸、凝血酶原时间和国际标准化比值(international normalized ratio,INR)均较低(均P<0.05);而血红蛋白和pH值均较高(均P<0.05);住院时间(13 d vs.15 d)较短(P<0.05);但两组之间出院好转率差异无统计学意义(P=0.308)。多因素Logistic回归分析发现:年龄(>68岁)、GCS评分(<5分)、血浆纤维蛋白原(fibrinogen,FIB)(24 h后,<2.04 g/L)和INR(24 h后,>1.455)是影响TIC患者预后的独立危险因素,AUC分别为0.632、0.702、0.733、0.752。结论TIC患者经PCC治疗可纠正凝血功能、缩短住院时间;年龄、GCS评分、24 h后的FIB及INR影响TIC患者临床预后,需要特别关注。Objective Efficacy of prothrombin complex concentration(PCC)and analysis of prognostic factors in patients with traumatic trauma-induced coagulopathy(TIC).Methods A retrospective study was conducted on patients with TIC admitted to 11 hospitals from January to December 2021.The data included baseline characteristics,injury information,blood product transfusions(including PCC treatment),laboratory examination at admission and 24 hour-after admission,treatment measure,pre-hospitalization time,and clinical outcomes(improvement at discharge,length of hospital stay).The patients were divided into a conventional group and a PCC group according to whether they were treated with PCC.Propensity score matching method was used to match the patients at a 1:1 ratio,and the differences in different indicators between the groups were compared.Univariate and multivariate logistic regression analyses were performed to identify prognostic factors for TIC patients.Results After propensity score matching,103 patients were identified in both the PCC and conventional groups.Univariate logistic regression analysis revealed no significant differences in age,gender,Glasgow Coma Scale(GCS)score,injury severity score,acute physiology and chronic health evaluation score,underlying diseases,pre-hospitalization time,injury type and site,and treatment measure(use of vasoactive drugs,calcium agents,tranexamic acid,and emergency surgery)between the two groups(all P>0.05).Compared with the conventional group,the PCC group exhibited lower 24-hour white blood cell counts,lactate level,prothrombin time,and international normalized ratio(INR)(all P<0.05),whereas hemoglobin level and pH value were higher(both P<0.05).The PCC group also had a shorter hospital stay(13 d vs.15 d,P<0.05).However,there was no significant difference in the rate of improvement at discharge between the two groups(P=0.308).Multivariate logistic regression revealed that age(>68 years),GCS score(<5 points),fibrinogen(FIB)level(after 24 h,<2.04 g/L),and INR(after 24 h,>1.455)were

关 键 词：创伤性凝血病 凝血酶原复合物 治疗效果 

分 类 号：R554[医药卫生—血液循环系统疾病]