CAJ | 학술논문

目的：探讨严重创伤患者预后与创伤性凝血病（TIC）相关性，分析影响预后的相关因素。方法选取严重创伤患者96例，所有患者入院后抽取静脉血10 ml和动脉血2 ml，进行血常规、凝血功能和相关生化检查及动脉血气分析。根据患者预后情况分为存活组（n=81）和死亡组（n=15），分析严重创伤预后与TIC的相关性，并分析性别、年龄、创伤时间、急性生理学及慢性健康状况评分（APACHE Ⅱ）、格拉斯哥昏迷评分（GCS）、创伤严重程度评分（ISS）、低体温等因素对严重创伤患者预后的影响。结果死亡组TIC发生率53.33%，明显高于存活组的12.34%，差异具有统计学意义（χ2=13.96，P＜0.05），TIC与严重创伤患者预后呈正相关（r=0.38，P＜0.05）。单因素结果显示：两组APACHEⅡ评分、GCS评分、ISS评分、血糖、血红蛋白（Hb）、红细胞比容（HCT）、血小板（Plt）、测定凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、国际标准化比值（INR）、休克指数≥1例数、体温＜35℃例数比较，差异均有统计学意义（t分别=4.01、4.94、3.93、3.42、4.81、6.23、4.85、6.48、4.36、3.64，χ2分别=7.19、7.82，P均＜0.05）。多因素logistic回归分析显示：APACHEⅡ评分升高、GCS评分降低、ISS评分升高、Plt计数降低和APTT时间延长是严重创伤患者预后的危险因素（OR分别=1.26、0.62、1.10、0.96、5.37，P均＜0.05）。结论严重创伤患者预后与TIC密切相关，APACHEⅡ评分升高、GCS评分降低、ISS评分升高、Plt计数降低和APTT时间延长是严重创伤患者预后的危险因素，提示临床实践中应进一步加强对TIC的防治。
목적：탐토엄중창상환자예후여창상성응혈병（TIC）상관성，분석영향예후적상관인소。방법선취엄중창상환자96례，소유환자입원후추취정맥혈10 ml화동맥혈2 ml，진행혈상규、응혈공능화상관생화검사급동맥혈기분석。근거환자예후정황분위존활조（n=81）화사망조（n=15），분석엄중창상예후여TIC적상관성，병분석성별、년령、창상시간、급성생이학급만성건강상황평분（APACHE Ⅱ）、격랍사가혼미평분（GCS）、창상엄중정도평분（ISS）、저체온등인소대엄중창상환자예후적영향。결과사망조TIC발생솔53.33%，명현고우존활조적12.34%，차이구유통계학의의（χ2=13.96，P＜0.05），TIC여엄중창상환자예후정정상관（r=0.38，P＜0.05）。단인소결과현시：량조APACHEⅡ평분、GCS평분、ISS평분、혈당、혈홍단백（Hb）、홍세포비용（HCT）、혈소판（Plt）、측정응혈매원시간（PT）、활화부분응혈활매시간（APTT）、국제표준화비치（INR）、휴극지수≥1례수、체온＜35℃례수비교，차이균유통계학의의（t분별=4.01、4.94、3.93、3.42、4.81、6.23、4.85、6.48、4.36、3.64，χ2분별=7.19、7.82，P균＜0.05）。다인소logistic회귀분석현시：APACHEⅡ평분승고、GCS평분강저、ISS평분승고、Plt계수강저화APTT시간연장시엄중창상환자예후적위험인소（OR분별=1.26、0.62、1.10、0.96、5.37，P균＜0.05）。결론엄중창상환자예후여TIC밀절상관，APACHEⅡ평분승고、GCS평분강저、ISS평분승고、Plt계수강저화APTT시간연장시엄중창상환자예후적위험인소，제시림상실천중응진일보가강대TIC적방치。
Objective To investigate the correlation of prognosis of patients with severe trauma and traumatic coagu-lopathy, and analysis the related influencing prognostic factors. Methods Ninety-six cases of patients with severe trauma were selected in emergency department. After admission, 10ml venous blood and 2 ml arterial blood were collected for de-tecting blood routine, coagulation, related biochemical tests and arterial blood gas analysis. All cases were divided into survival group(n=81) and death group(n=15) according to the prognosis of patients. The relationship between prognosis of patients with severe trauma and traumatic coagulopathy was analyzed and the influence to prognosis of the gender, age, traumatic time, APACHE Ⅱ scores, GCS scores, ISS scores, AIS scores and low body temperature and other indicators were analyzed. The severe trauma-related prognostic factors were analyzed. Results The incident rate of TIC in the deaths group was 53.33% which was significantly higher than the survival group of 12.34%(χ2=13.96, P<0.05). TIC was posi-tively correlated with prognosis of patients with severe trauma(r=0.38, P<0.05). The APACHEⅡ score, GCS score, ISS score, glucose, hemoglobin(Hb), hematocrit(HCT), platelet(Plt), prothrombin time(PT), activated partial thromboplas-tin time (APTT), international normalized ratio (INR), shock index≥1, the temperature<35℃ between two group were significantly different(t=4.01,4.94,3.93,3.42,4.81,6.23,4.85,6.48,4.36,3.64,χ2=7.19,7.82,P<0.05). The logistic anal-1.10,0.96,5.37,P<0.05). Conclusion Prognosis of patients with severe trauma was closely related to traumatic coagu-lopathy. Trauma severity, Plt count and APTT times were risk factors of prognosis of patients with severe trauma. It sug-gested that the prevention and treatment of traumatic coagulopathy should be further strengthen in clinical practice.