严重创伤患者创伤性凝血病的危险因素和诊断价值
Risk factors and diagnostic value of trauma-induced coagulopathy in patients with severe trauma
毛和飞 1徐政 1邱灿虎1
作者信息
- 1. 324100 江山,浙江省江山市人民医院
- 折叠
摘要
目的 探讨严重创伤患者创伤性凝血病(TIC)的危险因素.方法 回顾性分析 2020 年 1 月至 2023 年 3 月本院收治的 128 例严重创伤患者的临床资料,根据是否发生TIC将患者分为TIC组 52 例和非TIC组 76 例,比较两组血清学指标并分析创伤患者TIC的危险因素,采用受试者工作特征曲线(ROC)分析实验室指标早期诊断TIC的价值,比较不同TIC严重程度患者的血清学指标,并分析血清学指标与INR的相关性.结果 TIC组患者年龄、脉搏、ISS评分、休克指数显著高于非TIC组(P＜0.05);TIC组患者血小板计数、纤维蛋白原、血Ca2+水平显著低于非TIC组(P＜0.05),且重度组显著低于轻度组(P＜0.05);TIC组患者D-二聚体水平显著高于非TIC组(P＜0.05),且重度组显著高于轻度组(P＜0.05);Logistic回归分析结果显示,年龄、ISS评分、休克指数、血小板计数、纤维蛋白原、血Ca2+是创伤患者发生TIC的危险因素(P＜0.05),脉搏、D-二聚体与TIC无显著相关性(P＞0.05);ROC曲线分析结果显示,血Ca2+、血小板计数、纤维蛋白原早期诊断TIC的AUC分别为0.730、0.750、0.788;重度组患者血小板计数、纤维蛋白原、血Ca2+水平显著低于轻度组(P＜0.05),D-二聚体水平显著高于轻度组(P＜0.05);TIC患者血小板计数、纤维蛋白原、血Ca2+与INR 呈负相关(r=-0.464、-0.574、-0.579,P＜0.05),D-二聚体与INR 无显著相关性(r=0.254,P＞0.05).结论 血Ca2+、纤维蛋白原、血小板计数与严重创伤患者TIC的危险因素,在早期诊断TIC方面有潜在价值.
Abstract
Objective To investigate the Risk factors and diagnostic value of Trauma-induced coagulopathy(TIC)in patients with severe trauma.Methods Clinical data of patients with severe trauma admitted to our hospital from January 2020 to March 2023 were retrospectively analyzed,and the patients were divided into TIC group(52 cases)and non-TIC group(76 cases)according to whether they developed TIC.The risk factors of TIC in trauma patients were analyzed,and the value of Ca2+,fibrinogen and platelet count in early diagnosis of TIC was analyzed by receiver operating characteristic curve(ROC).The serological indexes of TIC patients with different severity were compared,and the correlation between serological indexes and INR was analyzed.Results The age,pulse,ISS score and shock index in TIC group were significantly higher than those in non-TIC group(P<0.05).The platelet count,fibrinogen and blood Ca2+levels in TIC group were significantly lower than those in non-TIC group(P<0.05),and the levels of severe group were significantly lower than those in mild group(P<0.05).The D-dimer level in TIC group was significantly higher than that of non-TIC group(P<0.05),and the level of severe group was significantly higher than that in mild group(P<0.05).Logistic regression analysis showed that age,ISS score,shock index,platelet count,fibrinogen and blood Ca2+were risk factors for TIC in trauma patients(P<0.05),there was no significant correlation between pulse,D-dimer and TIC(P＞0.05).ROC curve analysis results showed that the AUC of blood Ca2+,platelet count and fibrinogen early diagnosis of TIC were 0.730,0.750 and 0.788,respectively.Platelet count,fibrinogen and blood Ca2+were negatively correlated with INR in TIC patients(P<0.05),and there was no significant correlation between D-dimer with INR(P＞0.05).Conclusion Blood Ca2+,fibrinogen and platelet count are closely related to TIC in patients with severe trauma,which has potential value in early diagnosis of TIC.
关键词
创伤/创伤性凝血病/危险因素/血钙/纤维蛋白原/血小板计数Key words
Trauma/Trauma-induced coagulopathy/Risk factors/Blood calcium/Fibrinogen/Platelet count引用本文复制引用
基金项目
江山市指导性科技计划项目(JS2023D045)
出版年
2024
NETL
NSTL
万方数据