摘要
目的:探讨影响创伤性凝血病发生的危险因素,分析创伤性凝血病与多发创伤患者预后的关系。方法:选取2015-10-2017-09期间我院ICU收治的多发创伤患者117例,根据是否发生创伤性凝血病分为凝血病组和非凝血病组,比较两组患者性别、年龄、受伤原因、受伤至入院时间、入院时创伤严重程度评分(ISS)、急性生理和慢性健康评分Ⅱ(APACHEⅡ)、血压、体温、血pH值、红细胞压积等指标,并建立多因素回归方程,分析创伤性凝血病发生的危险因素。比较两组患者住ICU时间、住院时间、MODS发生例数等指标,并进行相关性分析,探讨创伤性凝血病对患者预后的影响。结果:117例多发创伤患者中,发生创伤性凝血病者29例,发生率为24.79%。与非凝血病组比较,凝血病组ISS评分及APACHEⅡ评分更高、低血压及低体温、酸中毒例数更多、红细胞压积更低(P<0.05),两组患者的性别、年龄、受伤原因、受伤至入院时间等指标比较差异均无统计学意义,Logistic多因素回归分析显示ISS评分及红细胞压积可作为创伤性凝血病发生的独立危险因素。凝血病组住ICU时间及住院时间更长、MODS例数更多(P<0.05),Spearman相关性分析显示创伤性凝血病的发生与MODS的发生呈正相关。结论:创伤性凝血病的发生与损伤严重程度、低血压、低体温、酸中毒、血液稀释等因素有关,其发生可致患者预后不良。
Objective：To investigate the risk factors that influence the occurrence of trauma induced coagulopathy,and to analyze the relationship between trauma induced coagulopathy and the prognosis of patients with multiple trauma.Method：One hundred and seventeen cases of patients with multiple trauma admitted to ICU of our hospital between October 2015 and September 2017 were selected,and were divided into coagulopathy group and noncoagulopathy group according to the occurrence of trauma induced coagulopathy.The indicators such as gender,age,injury mechanism,traumatic time,Injury Severity Score,Acute Physiology and Chronic Health Evaluation score,blood pressure,body temperature,blood pH,hematocrit were compared between the two groups.Multivariate logistic regression equation was formulated.Risk factors of trauma induced coagulopathy were analyzed.The time of stay in ICU,the time of stay in hospital,the occurrence of MODS were compared.Correlation analysis was conducted.The effect of trauma induced coagulopathy on the prognosis of the patients was studied.Result：Twentynine of 117 patients met the criteria of trauma induced coagulopathy,and the incident rate of TIC is 24.79%.Compared with the non-TIC group,the ISS,APACHEⅡscores of the TIC group were higher,cases of hypotension,hypothermia and acidosis were more,hematocrit was lower significantly（P〈0.05）.There was no significant difference in sex,age,injury mechanism and traumatic time between the two groups.Logistic regression analysis indicated ISS and Hct could be the independent risk factors involved in trauma induced coagulopathy.The time of stay in ICU and the time of stay in hospital were longer in TIC group,and the incidence of MODS was higher（P〈0.05）.The occurrence of trauma induced coagulopathy was positively correlated with the occurrence of MODS,which was considered in Spearman analysis.Conclusion：The occurrence of traumatic induced coagulopathy is associated with such factors as injury severity,hypotension,hypothermia,acidosis,and hemodilu
作者
王君
白颖
周宁
WANG Jun ,BAI ging ,ZHOU Ning(ICU, Beijing Jishuitan Hospital, Beijing, 100035, Chin)
出处
《临床急诊杂志》
CAS
2018年第2期113-116,共4页
Journal of Clinical Emergency
关键词
多发创伤
创伤性凝血病
危险因素
预后
multiple trauma
trauma induced coagulopathy
risk factors
prognosis
