医学论文：食管癌术前血细胞参数及凝血指标对创伤后并发症及死亡结局的预测价值.docVIP

　　摘要 目的:研究创伤患者血细胞参数及凝血指标的特征以及与创伤严重程度的关系。方法:创伤患者分为预后良好组和预后不良组,回顾性分析入院时所查静脉血的血常规和凝血四项指标,用spss软件进行统计学处理。结果:预后不良组的白细胞计数升高,血红蛋白及红细胞、血小板计数降低,凝血酶原时间、活化部分凝血活酶时间、凝血酶时间均延长,纤维蛋白原浓度降低,与预后良好组相比差异有统计学意义。结论:创伤患者血细胞参数改变和凝血功能紊乱对病情严重程度及预后有重要的判断价值。 　　关键词 创伤;预后;血常规;凝血功能 　　abstract objective:to investigate the changes of peripheral blood cells and coagulation markers of traumatic patients and to study the relationship between the changes and the severity of illness. methods:according to the prognosis, traumatic patients were divided into the good group and the bad group. the venous blood samples were taken from the patients at the admission day and following parameters were determined: red blood cells (rbc) , hemoglobin(hb), white blood cells(wbc), platelet (plt), prothrombin time(pt), activated partial thromboplastin time(aptt), thrombin time(tt) and fibrinogen(fib). statistical analysis was done by spss software. results:compared with the good group, wbc were heightened, hb, rbc and plt were declined in the bad group. pt, aptt and tt were longer but fib were lower in bad group than that in good group. all the difference were of statistical significance. conclusion:the changes of peripheral blood cells and coagulation dysfunction can be useful to judge the severity and prognosis of traumatic patients. 　　key words trauma;prognosis;peripheral blood cells;coagulation function 　　 　　创伤是对人类生命健康与社会生产的严重威胁之一,随着我国经济发展和工业化进程,尤其是交通运输的提速和高空作业的增多,创伤已成为继心脑血管疾病和恶性肿瘤之外最大的死亡原因。严重创伤的高死亡率和高致残率给家庭和社会带来沉重的负担,如何迅速判断伤情轻重、评估救治工作和预测进展结局,就显得尤为重要。本文旨在探讨创伤患者血细胞参数及凝血指标的特征以及与创伤严重程度的关系。 　　1 资料与方法 　　1.1 一般资料 　　2007年1月~2009年12月本院抢救治疗的严重创伤患者100例为预后不良组,其中,男69例,女31例,年龄14~82岁,平均37岁。48例患者死于急诊抢救室、外科手术室或icu,52例患者治疗过程中出现严重并发症,包括创伤失血性休克39例,感染、脓毒症31例,急性呼吸窘迫综合征(ards)15例、弥散性血管内凝血(dic)12例、多器官功能障碍综合征(mods)9例。选取同期收治的100例预后良好的创伤患者作为对照组,其中,男69例,女31例,年龄13~80岁,平均36岁。 　　1.2 研究方法 　　来院当日全部患者抽取的静脉血急查血常规和凝血四项,包括凝血酶原时间(pt),活化部分凝血活酶时间(aptt), 凝血酶时间(tt)和纤维蛋白原(fib),所有患者伤前均无血液系统疾病及肝肾功能损害,未服用止血、抗凝药物。 　　1.3 统计学处理 　　数据以均数±标准差(x±s)表示,应用sp