创伤骨折后多项血生化指标连续性检测临床意义.docVIP

创伤骨折后多项血生化指标连续性检测临床意义 　 作者：唐三元，杨辉，付海鹰，邢曙，赵灵，张宇，詹鹏 【摘要】 ［目的］探讨创伤骨折早期外周血生化指标变化特点，以期获得较准确的指标来预警并发症及多器官功能不全综合征（MODS）的发生，提高对伤情的早期判断和救治水平。［方法］从2002年4月～2004年12月本科收治的创伤患者中随机抽取48例，按AIS-ISS90进行创伤评分，分为重伤组和轻伤组，分别监测2组患者受伤当天，3、7、14 d的外周血糖，肌酐，尿素氮，血清酶学指标(LDH、CK、CKMB、LDL、GPT、GOT)，免疫球蛋白和补体(IgG、IgA、IgM、C3、C4)，CRP以及外周血白细胞、血小板、体温，记录出现并发症和MODS的结果，经统计学处理比较2组间上述指标的差异以及并发症发生率与上述指标之间的相关性。［结果］48例患者中，12例在轻伤组,36例在重伤组。重伤组患者血糖，LDH，CKMB，CRP明显高于轻伤组，LDL、IgG、IgA、IgM、C3、C4则低于轻伤组(Plt;0.01)；2组间GPT、GOT、肌酐，尿素氮无明显差别(Pgt;0.05)，重伤组中有2例发生ARDS(呼吸窘迫综合征)，3例合并上消化道出血，2例合并感染，6例发生了MODS，1例出现DIC，死亡1例，轻伤组1例MODS病例，1例感染，无死亡病例。［结论］多项外周血敏感生化指标的监测对于创伤骨折患者伤情及预后的判断有积极意义，且方法简便，容易实施，结合ISS创伤评分将使判断更趋准确。 【关键词】 创伤； 损伤； 骨折； 外周血； 生化指标 Abstract：［Objective］To investigate the clinical significance of changes in serum biochemical factors in trauma patients,and to improve the initial determination of the injury degree and rescue ratio.［Method］From April 2002 to December 2004,48 trauma patients were divided into two groups of serious and slight injury by ISS score.The author monitored the concentration of serum GLU,CR,BUN,LDH,CK,CKMB,LDL,GPT,GOT,IgG,IfA,IgM,C3,C4, CRP and the WBC,PLT,BT (body temperature) at the first day and after 3, 7, 14 days,recorded the therapy method and results. The difference between the two groups was compared by statistic method.［Result］In 48 patients, There were 12 in slight injury group, 36 in serious injury group.The concentration of GLU, LDH,CK,CKMB,CRP in serious group was more than that in slight group, but the concentration of LDL,IgG,IgA,IgM,C3,C4 was lower (Plt;0.01), there was no significant difference in CR, BUN,GPT,GOT(Pgt;0.05).There were 6 patients suffered MODS,2 cases suffered ARDS, 3 patients suffered upper digestive tract bleeding,2 cases combined with infection,1 case suffered DIC,and I death in serious group;there was 1 MODS,1 infection and no death in slight group.［Conclusion］The combined use of the AIS-ISS90 score and serum biochemical factors is advantageous to the determination of injury