摘要
目的探讨氨甲环酸联合纤维蛋白原对创伤性凝血病患者凝血功能、炎症因子及生存率的影响。方法选取本院2020年1月至2021年5月收治的创伤性凝血病患者108例,采用随机数表法分为对照组与观察组,每组54例。两组均采取常规对症治疗,观察组在此基础上采用氨甲环酸联合纤维蛋白原治疗。比较两组入院时、治疗后48 h的凝血功能、炎症因子、血制品用量及生存率。结果治疗后48 h,两组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)均较入院时降低,纤维蛋白原(Fib)、血小板(PLT)较入院时升高(P<0.05)。治疗后48 h,观察组的PT、APTT低于对照组,Fib、PLT高于对照组(P<0.05)。治疗后48 h,两组患者血清TNF-α、IL-6较入院时降低,血清IL-8较入院时升高(P<0.05)。观察组治疗后48 h的血清TNF-α、IL-6低于对照组,血清IL-8高于对照组(P<0.05)。观察组冷沉淀用量[(23.45±3.77)U vs.(25.58±4.12)U]、FFP用量[(812.88±89.45)ml vs.(868.68±94.11)ml]及RBC用量[(19.44±4.47)U vs.(22.68±5.34)U]均明显低于对照组(P<0.05)。观察组MODS发生率(44.44%vs.25.93%)、28 d病死率(29.63%vs.12.96%)、1年病死率(35.19%vs.16.67%)低于对照组(P<0.05)。结论氨甲环酸联合纤维蛋白原治疗创伤性凝血病疗效确切,可有效抑制纤溶亢进,有效控制出血,减少血制品输注,并减轻炎症反应,降低MODS发生率与死亡率。
Objective To investigate the effect of tranexamic acid combined with fibrinogen on the coagulation function,inflammatory factors and survival rate of patients with traumatic coagulopathy.Methods A total of 108 patients with traumatic coagulopathy admitted to our hospital from January 2020 to May 2021 were selected and divided into control group and observation group by random number table method,with 54 cases in each group.Both groups were treated with conventional symptomatic treatment,and the observation group was also treated with tranexamic acid combined with fibrinogen.The blood coagulation function,inflammatory factors on admission and at 48 hours after treatment,blood product dosage and survival rate of the two groups were compared.Results At 48 h after treatment,the PT and APTT of the two groups were lower than those on admission,while Fib and PLT were higher than those on admission(P<0.05).The PT and APTT of the observation group were lower than those of the control group at 48 h after treatment,and the Fib and PLT were higher than those of the control group(P<0.05).At 48 hours after treatment,the serum TNF-αand IL-6 of the two groups of patients were lower than those on admission,and the serum IL-8 was higher than that on admission(P<0.05).The serum TNF-αand IL-6 of the observation group were lower than those of the control group at 48 h after treatment,and the serum IL-8 was higher than that of the control group(P<0.05).The amount of cryoprecipitate in the observation group[(23.45±3.77)U vs.(25.58±4.12)U],the amount of FFP[(812.88±89.45)ml vs.(868.68±94.11)ml]and the amount of RBC[(19.44±4.47)U vs.(22.68±5.34)U]of the observation group were significantly lower than those of the control group(P<0.05).The incidence of MODS in the observation group(44.44%vs.25.93%),the 28-day mortality(29.63%vs.12.96%),and the 1-year mortality(35.19%vs.16.67%)were lower than those in the control group(P<0.05).Conclusion Tranexamic acid combined with fibrinogen has a definite curative effect in the treatment of traumatic coagulopathy.It can effectively inhibit hyperfibrinolysis,effectively control bleeding,reduce blood product transfusion,reduce inflammation,and decrease the incidence and mortality of MODS.
作者
李红月
斯小水
何建新
郑文娟
赵娴
陈丽丹
LI Hong-yue;SI Xiao-shui;HE Jian-xin;ZHENG Wen-juan;ZHAO Xian;CHEN Li-dan(Department of Critical Care Medicine,Yiwu Central Hospital,Yiwu 322000,China)
出处
《实用药物与临床》
CAS
2022年第3期205-209,共5页
Practical Pharmacy and Clinical Remedies
基金
浙江省医学会临床科研基金项目(2019ZYC-A168)。
关键词
氨甲环酸
纤维蛋白原
创伤性凝血病
凝血功能
炎症因子
生存率
Tranexamic acid
Fibrinogen
Traumatic coagulopathy
Coagulation function
Inflammatory factors
Survival rate
