CAJ | 학술논문

目的：探讨创伤患者血浆可溶性 P 选择素（sPsel）和血管性血友病因子（vWF）的入院后水平变化情况，及其与凝血指标水平、凝血障碍和预后的关系。方法前瞻性地选取该院 ICU 病房82例严重创伤患者，入院时及入院后第1周内每日检测患者血浆中 sPsel、vWF 抗原、蛋白 C、凝血因子Ⅶ活性及常规凝血指标，并记录患者入院30 d 病死率。结果有凝血障碍创伤患者的入院时 sPsel 和 vWF 水平均低于无凝血障碍的患者（P ＜0．05），且与各凝血指标（蛋白 C 和Ⅶ因子）水平均显著相关（P ＜0．05）。死亡患者 vWF 水平在入院后前3天显著低于生存患者（P ＜0．05），而在入院后第7天显著高于生存患者（P ＜0．05）；未发现生存患者与死亡患者间入院后1周内 sPsel 水平有明显不同。结论在 ICU 严重创伤患者中，入院时低水平的 sPsel 和vWF 水平与凝血障碍相关，vWF 水平在入院后第7天显著升高与患者30 d 病死率增高相关。
목적：탐토창상환자혈장가용성 P 선택소（sPsel）화혈관성혈우병인자（vWF）적입원후수평변화정황，급기여응혈지표수평、응혈장애화예후적관계。방법전첨성지선취해원 ICU 병방82례엄중창상환자，입원시급입원후제1주내매일검측환자혈장중 sPsel、vWF 항원、단백 C、응혈인자Ⅶ활성급상규응혈지표，병기록환자입원30 d 병사솔。결과유응혈장애창상환자적입원시 sPsel 화 vWF 수평균저우무응혈장애적환자（P ＜0．05），차여각응혈지표（단백 C 화Ⅶ인자）수평균현저상관（P ＜0．05）。사망환자 vWF 수평재입원후전3천현저저우생존환자（P ＜0．05），이재입원후제7천현저고우생존환자（P ＜0．05）；미발현생존환자여사망환자간입원후1주내 sPsel 수평유명현불동。결론재 ICU 엄중창상환자중，입원시저수평적 sPsel 화vWF 수평여응혈장애상관，vWF 수평재입원후제7천현저승고여환자30 d 병사솔증고상관。
Objective To investigate the change of soluble P-selectin (sPsel)and von Willebrand factor (vWF)levels after ad-mission in traumatic patients and their relation with the coagulation indexes levels,coagulation disorders and prognosis.Methods 82 cases of severe trauma in ICU of Affiliated Tongji Hospital were prospectively selected and detected plasma sPsel,VWF anti-gen,protein C,activity of coagulation factor Ⅶ and routine coagulation indexes on admission and on every day within the first week after admission.The 30 d fatality rate was recorded.Results The sPsel and vWF levels on admission in the patients with coagula-tion disorders were lower than those in the patients without coagulation disorders (P <0.05)and significantly correlated with the coagulation indexes (protein C and coagulation factor Ⅶ)levels (P <0.05).The vWF level within 3 d after admission in the death patients was significantly lower than that in the survival patients,but which on 7 d after admission in the death patients was signifi-cantly higher than that in the survival patients (P <0.05 );no significant difference in sPsel level within 1 week after admission were found between the survival patients and the death patients.Conclusion Among severe traumatic patients in ICU,the low lev-els of sPsel and VWF on admission are associated with the coagulation disorders,the significant rise of vWF level on 7 d after ad-mission is associated with the increase of the 30 d fatality rate.