人纤维蛋白原对急诊外伤致创伤性凝血病疗效及相关因素分析

目的:探讨人纤维蛋白原(fibrinogen，FIB)对急诊创伤性凝血病患者的临床疗效及相关因素。方法:将2015年6月至2018年6月本院收治的100例严重创伤患者纳入本研究，根据是否创伤性凝血病分为凝血病组(80例)和非凝血病组(20例)。比较凝血病组和非凝血病组患者收住后第1个24 h的急性生理和慢性健康评分(acute physiology and chronic health evaluation II，APACHE II)、创伤严重程度评分(injury severity score，ISS)、低体温及低灌注发生率等指标。采用Logistic多因素回归方法分析严重创伤患者发生创伤性凝血病的相关因素。将80例创伤性凝血病患者随机分为观察组(40例)和对照组(40例)。对照组按照常规诊疗措施治疗，观察组在对照组处理基础上给予人FIB，比较治疗前后观察组和对照组的凝血功能指标，及治疗后的临床用血量、住院时间及病死率。结果:与治疗前相比，治疗后观察组和对照组的凝血酶原时间(prothrombin time，PT)、活化部分凝血活酶时间(activated partial thromboplastin time，APTT)及D-二聚体水平降低(P<0.05)，FIB水平明显升高(P<0.05)。观察组的红细胞(red blood cell，RBC) 输注量、新鲜冰冻血浆(fresh frozen plasma，FFP)输注量、重症加强护理病房(intensive care unit，ICU)时间及病死率均明显低于对照组，差异具有统计学意义(P<0.05)。创伤性凝血病患者PT>18 s(r=0.623，P=0.024)、APTT>60 s(r=0.722，P=0.018)、凝血酶时间(thrombin time，TT)>15 s(r=0.719，P=0.033)与ISS评分呈正相关。碱缺失(base deficit，BD)≥6(OR=3.678，95%CI=1.065～9.417)、格拉斯哥评分(Glasgow coma scale，GCS)≤8(OR=5.299，95%CI=1.122～8.711)和血小板(platelet，PLT)计数(OR=0.982，95%CI=0.971～0.996)是严重创伤患者发生创伤性凝血病的独立预测因素。结论:人FIB可有效改善创伤性凝血病患者的凝血功能，降低病死率、缩短ICU时间，创伤性凝血病与创伤严重程度、合并休克、低体温和重型颅脑损伤存在一定的相关性。

Therapeutic effect and related factors of human fibrinogen on traumatic traumatic coagulopathy

AIM:To investigate the clinical efficacy of human fibrinogen(FIB) in patients with emergency traumatic coagulopathy and the related factors in patients with traumatic coagulopathy. METHODS:One hundred patients with severe trauma admitted to our hospital from June 2015 to June 2018 were included in the study. According to whether the traumatic coagulopathy，they were classified into coagulopathy group (80 cases) and non-coagulopathy group (20 cases). The acute physiology and chronic health evaluation II (APACHE II) and the injury severity score (ISS) of the first 24 h after admission，hypothermia and hypoperfusion incidence were compared between the patients in the coagulopathy group and the non-coagulopathy group. Logistic multivariate regression analysis was used to analyze the related factors of traumatic coagulopathy in patients with severe trauma. Eighty patients with traumatic coagulopathy were randomly divided into observation group (40 cases) and control group (40 cases). The control group was given conventional medical treatment. The observation group was given human fibrinogen based on the control group. The coagulation function indexes and the clinical blood volume，hospitalization time and mortality of of the observation group and the control group were compared.RESULTS:Compared with before treatment，the prothrombin time (PT)，activated partial thromboplastin time (APTT) and D-dimer levels were decreased，the level of fibrinogen (FIB) was significantly increased in the observation group and the control group after treatment(P<0.05). The red blood cell(RBC) infusion volume，fresh frozen plasma(FFP) infusion volume，intensive care unit(ICU) time and mortality rate of the observation group were significantly lower than those in the control group(P<0.05).Traumatic coagulation patients with PT>18 s (r=0.623，P=0.024)，APTT>60 s (r=0.722，P=0.018)，thrombin time(TT>15 s (r=0.719，P=0.033) were positively correlated with ISS scores. Base deficit(BD)≥6 (OR=3.678，95%CI=1.065-9.417)，Glasgow coma scale(GCS)≤8 (OR=5.299，95%CI=1.122-8.711) and platelet(PLT) count (OR=0.982，95%CI=0.971-0.996) were the independent predictors of traumatic coagulopathy in patients with severe trauma.CONCLUSION:Human FIB can effectively improve the coagulation function of patients with traumatic coagulopathy，reduce the mortality rate，shorten the ICU time，and there is certain correlation between traumatic coagulopathy and trauma severity，combined with shock，hypothermia and severe craniocerebral injury.