CAJ | 학술논문

目的：研究早期应用乌司他丁对多发伤患者凝血功能和临床预后的影响。方法：选取2013年7月-2014年7月收住本院ICU的多发伤患者40例为研究对象，随机均分为常规组和乌司他丁组，每组各20例，ISS评分均≥16分。常规组按多发伤常规治疗，乌司他丁组在常规治疗基础上于入院后立即开始静脉滴注乌司他丁40万U/12 h。动态观察两组治疗前和治疗后第3天、第5天及第7天血小板计数（PLT）、凝血酶时间（TT）、凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）、纤维蛋白原（FIB）、D-二聚体（D-D）变化，同时记录患者入住时急性生理和慢性健康状态评分（APACHE II）、ICU住院天数、MODS发生率和28 d死亡率。结果：两组入院时ISS评分、APACHE II评分及凝血功能比较差异均无统计学意义（P>0.05）。治疗1周后乌司他丁组PLT、PT、APTT、FIB及D-D的改善较常规组明显，两组比较差异均有统计学意义（P<0.05）。乌司他丁组并发MODS率、死亡率均低于常规组，住ICU平均天数明显短于常规组，两组比较差异均有统计学意义（P<0.05）。结论：多发伤患者早期使用乌司他丁静脉滴注可加速多发伤患者PLT计数、PT、APTT、FIB及D-D异常的改善，并降低ICU住院天数、MODS发生率及28 d死亡率。
목적：연구조기응용오사타정대다발상환자응혈공능화림상예후적영향。방법：선취2013년7월-2014년7월수주본원ICU적다발상환자40례위연구대상，수궤균분위상규조화오사타정조，매조각20례，ISS평분균≥16분。상규조안다발상상규치료，오사타정조재상규치료기출상우입원후립즉개시정맥적주오사타정40만U/12 h。동태관찰량조치료전화치료후제3천、제5천급제7천혈소판계수（PLT）、응혈매시간（TT）、응혈매원시간（PT）、활화부분응혈매원시간（APTT）、섬유단백원（FIB）、D-이취체（D-D）변화，동시기록환자입주시급성생리화만성건강상태평분（APACHE II）、ICU주원천수、MODS발생솔화28 d사망솔。결과：량조입원시ISS평분、APACHE II평분급응혈공능비교차이균무통계학의의（P>0.05）。치료1주후오사타정조PLT、PT、APTT、FIB급D-D적개선교상규조명현，량조비교차이균유통계학의의（P<0.05）。오사타정조병발MODS솔、사망솔균저우상규조，주ICU평균천수명현단우상규조，량조비교차이균유통계학의의（P<0.05）。결론：다발상환자조기사용오사타정정맥적주가가속다발상환자PLT계수、PT、APTT、FIB급D-D이상적개선，병강저ICU주원천수、MODS발생솔급28 d사망솔。
Objective:To investigate the effect of early application of ulinastatin on coagulation system and clinical outcomes in multiple trauma patients.Method:40 multiple trauma patients were selected in our ICU from July 2013 to July 2014 and randomly divided into common treatment group and ulinastatin group,20 cases in each group. The injury severity score (ISS) were more than 16 points in all patients. Common group was given conventional treatment, while ulinastatin group was treated intravenous infusion of ulinastatin immediately after admission on the basis of routine therapy. The dose of ulinastatin was 40 kU every 12 hours. Dynamic observation of the changes of the platelet count (PLT), thrombin time (TT), prothrombin time (PT), activated partial prothrombin time (APTT), fibrinogen (FIB) and D-dimer (D-D) of two groups before and after treatment(3,5 and 7 days) were compared.At the same time, the acute physiology and chronic health score(APACHE II),ICU hospitalization days, MODS incidence and 28 day mortality were recorded.Result:There were no statistical differences between ISS score, APACHE II score and coagulation function on admission of two groups (P>0.05). After treatment, the improvement of the PLT,TT,PT,APTT,FIB and D-D were better in ulinastatin group than that common group, the differences were statistically significant(P<0.05).The MODS incidence, 28 day mortality and ICU hospitalization days of ulinastatin group were significantly lower than common group,the differences were statistically significant(P<0.05).Conclusion:Ulinastatin injection could improve PLT,TT,PT,APTT,FIB and D-D;decrease MODS incidence, 28 d mortality and ICU hospitalization days in traumatic coagulopathy patients.