急性重症创伤患者急性生理学与慢性健康状况评分Ⅱ及凝血指标对预后判断意义
|
摘要
目的探讨急性重症创伤患者凝血功能障碍与病情严重程度及预后的关系。方法选取河北省石家庄市第三医院急诊科自2015年4月至2016年3月收治的68例针对性重症创伤患者为研究对象。根据损伤严重评分(ISS)分为非危重组(ISS评分≤16分,n=12)、危重组(ISS评分17～25分,n=31)及极危重组(ISS评分> 25分,n=25)。同期选择30例行体检健康者作为健康组。入院24 h,检测及评估凝血酶原时间(PT)、部分活化凝血酶原时间(APTT)、纤维蛋白原浓度(FIB)、D-二聚体(D-D)、血小板计数(PLT)及急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)。结果重症创伤患者PT、APTT、DD、APACHEⅡ评分均显著高于健康组,FIB、PLT低于健康组(P <0. 05);极危重组PT、APTT、D-D、APACHEⅡ评分明显高于非危重组和危重组,FIB、PLT明显低于非危重组和危重组(P <0. 05);危重组PT、APTT、D-D、APACHEⅡ评分明显高于非危重组,FIB、PLT明显低于非危重组(P <0. 05)。APACHEⅡ评分与PT、APTT、D-D呈正相关性(r值分别为0. 321、0. 472、0. 412,P <0. 05),与FIB、PLT呈负相关性(r=-0. 324、0. 412,P <0. 05)。结论急性重症创伤患者血清PT、APTT、FIB、D-D、PLT等凝血功能指标与APACHEⅡ评分具有良好的相关性,一定程度能够反映出急性重症创伤患者的疾病严重程度,也可作为评估患者预后的有效指标。
Objective To investigate the relationship between the severity and prognosis of coagulation dysfunction in patients with acute severe trauma. Methods A retrospective study was performed on 68 cases of patients with acute severe trauma who were admitted from April 2015 to March 2016. According to the serious injury score(ISS),patients were divided into the non-severe group(ISS score 16 or less,n = 12),critical group(ISS score 17 to 25,n = 31),extremely critical group(ISS score > 25,n = 25). At the same time choose healthy check-up volunteers,30 cases as the healthy group. Within 24 hours of admission test detection and evaluation of prothrombin time(PT),part of the activation of prothrombin time(APTT),concentration of fibrinogen(FIB),D-dimer(D-D),platelet count(PLT) in acute physiology and chronic health evaluation(APACHE Ⅱ) system were performed. Results The patients with severe trauma,PT,APTT,D-D and APACHE Ⅱ scores were significantly higher than those of the healthy group,FIB and PLT were significantly lower than those in the healty group(P < 0. 05); extremely critical set of PT,APTT,D-D,APACHE Ⅱ scores were significantly higher than those in the non-severe group and critical group,FIB and PLT were significantly lower than those in the non-severe group and critical group(P < 0. 05); PT,APTT,D-D,APACHE Ⅱ scores in the critical group were significantly higher than those in the non-severe group,FIB and PLT were significantly lower than those in the non-severe group(P < 0. 05). APACHE Ⅱ score was positively correlated with PT,APTT,D-D(r = 0. 321,0. 472,0. 412,P < 0. 05),and negatively correlated with FIB and PLT(r =-0. 324,0. 412,P < 0. 05). Conclusion Patients with acute severe trauma serum PT,APTT,FIB,D-D,PLT such blood coagulation functions index have good correlation with APACHE Ⅱ score,in a certain extent can reflect the severity of disease in patients with acute severe trauma,which can be used as evaluation of prognosis in patients with effective index.
Objective To investigate the relationship between the severity and prognosis of coagulation dysfunction in patients with acute severe trauma. Methods A retrospective study was performed on 68 cases of patients with acute severe trauma who were admitted from April 2015 to March 2016. According to the serious injury score(ISS),patients were divided into the non-severe group(ISS score 16 or less,n = 12),critical group(ISS score 17 to 25,n = 31),extremely critical group(ISS score > 25,n = 25). At the same time choose healthy check-up volunteers,30 cases as the healthy group. Within 24 hours of admission test detection and evaluation of prothrombin time(PT),part of the activation of prothrombin time(APTT),concentration of fibrinogen(FIB),D-dimer(D-D),platelet count(PLT) in acute physiology and chronic health evaluation(APACHE Ⅱ) system were performed. Results The patients with severe trauma,PT,APTT,D-D and APACHE Ⅱ scores were significantly higher than those of the healthy group,FIB and PLT were significantly lower than those in the healty group(P < 0. 05); extremely critical set of PT,APTT,D-D,APACHE Ⅱ scores were significantly higher than those in the non-severe group and critical group,FIB and PLT were significantly lower than those in the non-severe group and critical group(P < 0. 05); PT,APTT,D-D,APACHE Ⅱ scores in the critical group were significantly higher than those in the non-severe group,FIB and PLT were significantly lower than those in the non-severe group(P < 0. 05). APACHE Ⅱ score was positively correlated with PT,APTT,D-D(r = 0. 321,0. 472,0. 412,P < 0. 05),and negatively correlated with FIB and PLT(r =-0. 324,0. 412,P < 0. 05). Conclusion Patients with acute severe trauma serum PT,APTT,FIB,D-D,PLT such blood coagulation functions index have good correlation with APACHE Ⅱ score,in a certain extent can reflect the severity of disease in patients with acute severe trauma,which can be used as evaluation of prognosis in patients with effective index.
引文
[1]包义君,王鹏飞,陶山伟,等.急性单发性创伤性颅脑损伤术后凝血功能障碍与肝功能异常的相关性[J].中国医科大学学报,2016,45(3):209-212.
[2] Tonglet ML,Minon JM,Seidel L,et al. Prehospital identification of trauma patients with early acute coagulopathy and massive bleeding:results of a prospective non-interventional clinical trial evaluating the trauma induced coagulopathy clinical score(TICCS)[J].Crit Care,2014,18(6):648.
[3] Heimdal A,Stoylen A,Torp H,et al. Real-time strain rtee imaging of the left ventricle by ultrasound[J]. J Am Soc Echocardiogr,1998,11(11):1013-1019.
[4] Knaus WA,Draper EA,Wanger DP,et al. APACHEⅡ:a severity of classification system[J]. Crit Care Med,1985,13(40):818-829.
[5]金慧,万鹏,彭娜,等.凝血和血小板功能监测仪在创伤性凝血病早期诊断中的应用评价[J].中国急救复苏与灾害医学杂志,2014,9(8):696-701.
[6] Shenkman B,Budnik I,Iinav Y,et al. Model of trauma-induced coagulopathy including hemodilution,fibrinolysis,acidosis,and hypothermia:Impact on blood coagulation and platelet function[J]. J Trauma Acute Care Surg,2017,82(2):287-292.
[7] Mitra B,Cameron PA,Mori A,et al. Early prediction of acute traumatic coagulopathy[J]. Resuscitation,2011,82(9):1208-1213.
[8] Whittaker B,Christiaans SC,Altice JL,et al. Early coagulopathy is an independent predictor of mortality in children after severs trauma[J]. Shock,2013,39(5):421-426.
[9]徐旭,李志伟,董浩,等.肿瘤坏死因子-α、白细胞介素-6、血小板活化因子与重症颅脑损伤凝血功能障碍的相关性探讨[J].中国医师进修杂志,2014,37(5):31-34.
[10]杨婧,李俊杰,虎晓岷,等.创伤患者创伤性凝血病的相关因素分析[J].临床急诊杂志,2015,16(12):909-911.
[11] Zhu R,Wei S,Wu C,et al. Utility of clot formation and lysis assay to monitor global coagulation staet of patients with severe acute pancreatitis[J]. Dig Dis Sci,2012,57(5):1399-1403.
[12]程燕东,郑少军,杨勤,等.急性胰腺炎凝血功能变化及疾病严重程度和预后的关系研究[J].中华全科医学,2016,14(7):1138-1140.
[13] Watts S,Nordmann G,Brohi K,et al. Evaluation of prehospital blood products to attenuate acute coagulopathy of trauma in a model of severe injury and shock in anesthetized pigs[J]. Shock,2015,1:138-148.
[14]刘红升,王曼,苏琴,等.急性重症创伤患者凝血功能异常的临床意义[J].创伤外科杂志,2014,16(5):399-402.
[15]李涛.重症创伤对冀图功能障碍的影响研究[J].吉林医学,2015,36(5):959-960.
[2] Tonglet ML,Minon JM,Seidel L,et al. Prehospital identification of trauma patients with early acute coagulopathy and massive bleeding:results of a prospective non-interventional clinical trial evaluating the trauma induced coagulopathy clinical score(TICCS)[J].Crit Care,2014,18(6):648.
[3] Heimdal A,Stoylen A,Torp H,et al. Real-time strain rtee imaging of the left ventricle by ultrasound[J]. J Am Soc Echocardiogr,1998,11(11):1013-1019.
[4] Knaus WA,Draper EA,Wanger DP,et al. APACHEⅡ:a severity of classification system[J]. Crit Care Med,1985,13(40):818-829.
[5]金慧,万鹏,彭娜,等.凝血和血小板功能监测仪在创伤性凝血病早期诊断中的应用评价[J].中国急救复苏与灾害医学杂志,2014,9(8):696-701.
[6] Shenkman B,Budnik I,Iinav Y,et al. Model of trauma-induced coagulopathy including hemodilution,fibrinolysis,acidosis,and hypothermia:Impact on blood coagulation and platelet function[J]. J Trauma Acute Care Surg,2017,82(2):287-292.
[7] Mitra B,Cameron PA,Mori A,et al. Early prediction of acute traumatic coagulopathy[J]. Resuscitation,2011,82(9):1208-1213.
[8] Whittaker B,Christiaans SC,Altice JL,et al. Early coagulopathy is an independent predictor of mortality in children after severs trauma[J]. Shock,2013,39(5):421-426.
[9]徐旭,李志伟,董浩,等.肿瘤坏死因子-α、白细胞介素-6、血小板活化因子与重症颅脑损伤凝血功能障碍的相关性探讨[J].中国医师进修杂志,2014,37(5):31-34.
[10]杨婧,李俊杰,虎晓岷,等.创伤患者创伤性凝血病的相关因素分析[J].临床急诊杂志,2015,16(12):909-911.
[11] Zhu R,Wei S,Wu C,et al. Utility of clot formation and lysis assay to monitor global coagulation staet of patients with severe acute pancreatitis[J]. Dig Dis Sci,2012,57(5):1399-1403.
[12]程燕东,郑少军,杨勤,等.急性胰腺炎凝血功能变化及疾病严重程度和预后的关系研究[J].中华全科医学,2016,14(7):1138-1140.
[13] Watts S,Nordmann G,Brohi K,et al. Evaluation of prehospital blood products to attenuate acute coagulopathy of trauma in a model of severe injury and shock in anesthetized pigs[J]. Shock,2015,1:138-148.
[14]刘红升,王曼,苏琴,等.急性重症创伤患者凝血功能异常的临床意义[J].创伤外科杂志,2014,16(5):399-402.
[15]李涛.重症创伤对冀图功能障碍的影响研究[J].吉林医学,2015,36(5):959-960.