陈玉生 陈海湛 高海军 赵国江 刘卫明

【摘要】 目的：探討高处坠落严重多发伤并发创伤性凝血病的影响因素。方法：选择2018年1月-2019年6月笔者所在医院治疗的高处坠落严重多发伤并发创伤性凝血病患者74例作为研究对象，进行回顾性分析。根据患者入院后48 h凝血功能检查结果，将31例凝血功能障碍的患者作为观察组，将非凝血功能障碍的43例患者作为对照组。比较两组患者的体温、酸中毒、碱缺失、是否合并颅脑损伤、休克、GCS评分、血红蛋白计数、血小板计数、ISS评分及急性生理与慢性健康（APACHEⅡ）评分等指标和两组患者凝血指标。结果：观察组低体温、酸中毒、碱缺失、合并颅脑损伤、休克、GCS评分≤6分发生率高于对照组（P<0.05）;观察组的血红蛋白、血小板计数低于对照组，观察组的ISS评分和APACHEⅡ评分高于对照组（P<0.05）;多因素Logistic分析表明，创伤性凝血病与低体温、酸中毒、GCS评分≤6分及合并颅脑损伤有关，均为独立危险因素;观察组的PT、TT、APTT时间明显长于对照组，观察组的血小板计数和纤维蛋白原指标低于对照组（P<0.05）。结论：低体温、酸中毒、GCS评分≤6分及合并颅脑损伤是引发高处坠落严重多发伤并发创伤性凝血病的独立危险因素，凝血指标的可判断病情严重程度及预后评估，临床对危险因素及凝血指标加以重视，并进行针对性救治，可提高患者的存活率。

【关键词】 高处坠落 多发伤 创伤性凝血病 影响因素

doi：10.14033/j.cnki.cfmr.2020.12.075 文献标识码 B 文章编号 1674-6805（2020）12-0-03

Factors Affecting Traumatic Coagulopathy of Severe Multiple Injuries from High Places/CHEN Yusheng， CHEN Haizhan， GAO Haijun， ZHAO Guojiang， LIU Weiming. //Chinese and Foreign Medical Research， 2020， 18（12）： -179

[Abstract] Objective： To investigate the influencing factors of traumatic coagulopathy of severe multiple injuries in high places. Method： A total of 74 case patients with severe multiple trauma and traumatic coagulopathy who were treated in our hospital from January 2018 to June 2019 were selected for retrospective analysis. According to the results of blood coagulation function examination 48 hours after admission， 31 patients with coagulopathy were used as observation group， and 43 patients with non-coagulopathy were used as control group. The body temperature， acidosis， alkali deficiency， merger， brain injury， shock， GCS score， hemoglobin count， platelet count， ISS score， and acute physiology and chronic health （APACHEⅡ） scores and differences in coagulation parameters were compared between the two groups. Result： The incidence of hypothermia， acidosis， alkali deficiency， combined brain injury， shock， and GCS scores ≤6 points in the observation group was higher than those in the control group （P<0.05）. The hemoglobin and platelet counts of the observation group were lower than those of the control group， and the ISS score and APACHEⅡscore of the observation group were higher than those of the control group （P<0.05）. The multivariate Logistic analysis showed that traumatic coagulopathy was associated with hypothermia， acidosis， GCS score ≤6 points and combined brain injury. The time of PT， TT and APTT in the observation group were significantly longer than those in the control group， the platelet count and fibrinogen index in the observation group were lower than those of the control group （P<0.05）. Conclusion： Hypothermia， acidosis， GCS score ≤6 points and combined brain injury are independent risk factors for severe multiple trauma and traumatic coagulopathy. The coagulation index can judge the severity and prognosis of the disease. Risk factors and coagulation indicators are taken seriously， and targeted treatment can improve the survival rate of patients.

[Key words] Falling from high places Multiple injuries Traumatic coagulopathy Influencing factors

First-authors address： Dalang Hospital of Dongguan， Dongguan 523770， China

高处坠落是常见的危险事件之一，是在高空作业或意外情况下发生的，且发生率高，发生的原因是由人的因素和物的因素导致的。发生高处坠落会使机体受到严重的多发伤，抢救的重点是进行抗休克，止血的处理。在严重多发伤患者中创伤性凝血病的并发率高，且与预后有密切的关系。创伤性凝血病是由于机体受到严重的创伤下发生的以凝血功能障碍为主要表现的临床综合征，病死率高达50%以上[1]。创伤性凝血病的病理原因复杂，其发生因素于抗凝、凝血、纤溶机制的相互作用有关，另外与机体严重损伤、体温低、休克、酸中毒和炎症反应等因素也有关，并且各个因素之间相互关联，发病的确切因素尚不明确[2]。……