ICU中创伤性凝血病影响因素与临床意义.docVIP

ICU中创伤性凝血病影响因素与临床意义 　　【摘要】目的 探讨重症监护病房（ICU）中创伤性凝血病的影响因素及对严重创伤患者预后的影响。方法 回顾性收集2008年6月至2009年9月伤后24 h内收住浙江大学医学院附属第二医院院急诊ICU的223例严重创伤患者的资料，记录损伤严重程度评分（ISS）、急性生理和慢性健康评分（APACHEⅡ）、收住时的凝血功能、血常规、生化常规和血气分析等指标。以需要血管活性药物维持血压、碱缺失（BD）≥6和休克指数（SI）≥1作为存在组织低灌注的标准。根据凝血功能结果将患者分为凝血病组和无凝血病组（对照组）。比较两组间创伤严重程度、APACHE Ⅱ值、低体温及低灌注发生率等指标，分析创伤性凝血病的影响因素，并建立多因素回归方程。比较死亡与存活患者凝血功能指标及创伤性凝血病的发生率。结果 52例（23.3%）符合创伤性凝血病的诊断，病死率明显高于对照组（36.5% vs 9.4%， P 　　【关键词】严重创伤；创伤性凝血病；危险因素；预后 　　Risk factors and clinical effects of trauma induced coagulopathy in ICU patients with major trauma XU Shan—xiang， WANG Lian， YANG Jian—xin， ZHOU Guang—ju， ZHANG Mao. Department of Emergency Medicine， Second Affiliated Hospital of Zhejiang University School of Medicine，Institute of Emergency Medicine， Hangzhou 310009， China 　　Corresponding author：ZHANG Mao ， Email：zmhz@ 　　【Abstract】Objective To investigate the risk factors of trauma induced coagulopathy and its effect on the outcome of ICU patients with severe trauma. Methods Totally 223 severe trauma patients admitted to emergency ICU within 24h after injuring between June， 2008 and September， 2009 were retrospectively analyzed. Injury severity score （ISS）， APACHE Ⅱ score， coagulation function， routine blood test， biochemical test， and blood gas assay were completed for each patient. Hypoperfusion was defined as vasoactive agents usage， or base deficit （BD） ≥6 or shock index ≥1. Patients were divided into coagulopathy group and non—coagulopathy （control） group according to coagulation function. ISS， APACHE Ⅱ score， the occurrence of hypothermia and hypoperfusion were compared between the two groups. The risk factors of trauma induced coagulopathy were analyzed， and the multivariate logistic regression equation was formulated. Coagulation function and incidence of trauma induced coagulopathy were compared between non—survival and survival group. Results Fifty—two of 223 （23.3%） patients met the criteria of trauma induced coagulopathy. Mortality rate in this group was significantl