贵州医科大学学报

2014, v.39;No.171(06) 854-857

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创伤早期血糖水平和凝血指标与创伤病情的关系
Relationship of Early Stage Trauma Patients' Blood Glucose Levels and Blood Coagulation Indexes with Patients' Condition

华文良;何建刚;顾强;金益;汤超;李响;
HUA Wenliang;HE Jiangang;GU Qiang;JIN Yi;TANG Chao;LI Xiang;Emergency Department,the First People's Hospital of Taicang;

摘要(Abstract):

目的:探讨创伤早期血糖水平及凝血指标与创伤病情的关系。方法:根据入院24 h内的急性生理及慢性健康状况评分Ⅱ(APAHEⅡ评分)200例创伤患者,分为轻型组146例(APACHEⅡ<20分)和重型组54例(APACHEⅡ≥20分),根据创伤患者14 d的预后情况,分为存活组167例和死亡组33例,根据创伤患者入院时有无休克,分为无休克组162例和休克组38例,检测各组患者的血糖(BG)以及凝血指标,包括血小板(Plt)、血小板压积(PCT)、大血小板比率(PLCR)、血小板平均容积(MPV)、血小板分布宽度(PDW)、凝血酶原时间(PT)、凝血酶原活动度(PTA)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)、D-二聚体(D-Dimer)和血清钙离子(Ca2+)。结果:与轻型组比较,重型组患者的BG水平及PLCR、MPV、PDW、PT、APTT、TT、D-Dimer指标明显升高,Plt、PCT、PTA、FIB水平明显降低,差异有统计学意义(P<0.05);与存活组比较,死亡组患者的BG、PT和D-Dimer水平明显升高,PTA水平明显降低,差异有统计学意义(P<0.05);与无休克组比较,休克组患者BG、PDW、PT、APTT和TT水平明显升高,Plt、血清Ca2+、PTA和FIB水平明显降低,差异有统计学意义(P<0.05)。结论:创伤患者早期血糖升高、凝血障碍的严重程度与创伤的严重程度、死亡风险和休克发病风险有关,可作为预测创伤预后的辅助指标。
Objective: To investigate the relationship of blood glucose levels and blood coagulation indexes of early trauma patients on patients' condition. Methods: 200 trauma patients were selected as the research objects. According to the acute physiology and chronic health evaluation II score( APAHE II score) of the patients admitted within 24 hours,146 patients were divided into the mild group( APACHE Ⅱ < 20) and 54 in severe group( APACHE Ⅱ≥20). According to patients' prognosis after14 days,the patients were divided into the survival group( 167) and the death group( 33). According to whether the patients were complicated with shock when admission,the patients were divided into the non-shock group( 162) and the shock group( 38). The blood glucose( BG) and coagulation indexes,including platelet( Plt),platelet hematocrit( PCT),platelet large cell ratio( PLCR),mean platelet volume( MPV),platelet distribution width( PDW),prothrombin time( PT),prothrombin activity( PTA),activated partial thromboplastin time( APTT),fibrinogen( FIB),thrombin time( TT),DDimer and serum calcium( Ca2 +),were tested. Results: The levels of BG,PLCR,MPV,PDW,PT,APTT,TT,D-Dimer of the patients in severe group were significantly higher than those in the mild group,while Plt,PCT,PTA,FIB levels were lower than those in the mild group( P < 0. 05);the BG,PT,D-Dimer levels of the patients in death group were significantly higher than those in the survival group,while the PTA level was significantly lower( P < 0. 05); the BG,PDW,PT,APTT,TT levels of the patients in the shock group were significantly higher than those in the non-shock group,and the Plt,serum Ca2 +,PTA,FIB levels were significantly lower than those in the non-shock group,differences were statistically significant( P < 0. 05). Conclusions: The hyperglycemia and blood coagulation disorder of early trauma patients are related with the severity of the injury,the risk of death and shock,and can be used as the auxiliary index for predicting the patients' prognosis.

关键词(KeyWords): 血糖;凝血;创伤;预后;相关性;实验室检测
blood glucose;blood coagulation;trauma;prognosis;correlation;laboratory detection

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作者(Author): 华文良;何建刚;顾强;金益;汤超;李响;
HUA Wenliang;HE Jiangang;GU Qiang;JIN Yi;TANG Chao;LI Xiang;Emergency Department,the First People's Hospital of Taicang;

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