早期补充凝血底物对严重创伤合并创伤性凝血病治疗的临床研究(1)
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[摘要] 目的 探讨早期补充凝血底物治疗严重创伤合并创伤性凝血病的临床疗效。方法 72例严重创伤合并创伤性凝血病患者随机分为对照组(36例)和治疗组(36例)：对照组在浓缩红细胞复苏或手术后输注血浆、血小板、纤维蛋白原、凝血酶原复合物等凝血底物，治疗组在输注首剂红细胞或术前给予凝血底物。分别分析两组在术后12h和5d的凝血、纤溶指标和15d病死率及致残率。结果 与对照组比较，治疗组术后凝血、纤溶指标明显改善；治疗组病死率和致残率明显低于对照组(P<0.05)。结论 严重创伤合并创伤性凝血病患者早期实施凝血底物治疗对改善凝血功能、提高术后生活质量有重要意义。
[关键词] 凝血底物；严重创伤合并创伤性凝血病；红细胞复苏；凝血功能
[中图分类号] R641 [文献标识码] B [文章编号] 1673-9701(2011)34-124-02
The Clinical Research on Treatment of Severe Trauma Patients with Traumatic Coagulopathies by Supplement of Blood Coagulation Substrates at Earlier Stage
PAN Guanghua XU Qingyu ZHENG Xudong CHEN Chunbai WU Haibin
Emergency Center，Rui' an People' s Hospital，Rui'an 325200，China
[Abstract] Objective To explore clinical effect of supplement of blood coagulation substrates in earlier stage for severe trauma patients with traumatic coagulopthies. Methods All of 72 patients with traumatic coagulopthies were randomly divided into control group(n=36)and thearpy group(n=36). The patients in control group were received blood coagulation substrates including platelets，blood plasma，prothrombin complex after transfusion of concentrated RBC as resuscitation. Patients in therapy group received blood coagulation substrates before the first dose of transfusion of red blood cell(RBC)units or pre-operation. The blood coagulation functions were analyzed after 12h and 5d of post-operation. The rates of mortality and Mutilation were analyzed. Results Compared to control group，the thearpy group showed a quicker recovery of blood coagulation function(P<0.05). The rates of mortality and Mutilation in the therapy group were lower than control group(P<0.05). Conclusion Supplement of blood coagulation substrates at earlier stage was is feasible in the treatment severe trauma patients with traumatic coagulopathies.
[Key words] Blood coagulation substrates；Severe trauma patients with traumatic coagulopathies；Red cell recovery；Coagulation function
创伤性凝血病是指由于大出血及组织损伤后激活凝血、纤溶、抗凝途径，在创伤早期出现的凝血功能紊乱[1]。创伤凝血病发病率和死亡率较高，并且与预后密切相关[2]。目前认为创伤性凝血病的发病原因主要与组织损伤、休克、血液稀释、低体温、酸中毒和炎性反应等因素有关[3]。传统治疗创伤性凝血病通常在浓缩红细胞复苏或者手术后给予患者输注凝血底物如血浆、血小板、纤维蛋白原或凝血酶原复合物等 ......
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