交通创伤患者继发创伤性凝血功能障碍的危险因素分析

doi:10.11958/20242187

摘要/Abstract

摘要：

目的探讨交通创伤患者继发创伤性凝血功能障碍的危险因素。方法选择安徽医科大学第一附属医院（东城院区）急诊外科2022年4月—2023年3月交通创伤患者122例，根据是否继发创伤性凝血功能障碍分为发生组（n=30）和未发生组（n=92）。比较2组患者体温、酸中毒、头颅CT复查血肿增大、入院时格拉斯哥昏迷评分（GCS）、创伤严重程度评分（ISS）、血小板计数（PLT）、血红蛋白（Hb）等资料；多因素Logistic回归分析交通创伤患者继发创伤性凝血功能障碍的危险因素；受试者工作特征（ROC）曲线分析相关因素对继发创伤性凝血功能障碍的预测价值。结果发生组体温、入院时GCS、PLT、Hb低于未发生组，而ISS、酸中毒发生率、头颅CT复查血肿增大发生率高于未发生组（均P<0.01）；多因素Logistic回归分析显示，入院时GCS低、Hb水平低、ISS高、发生酸中毒、头颅CT复查血肿增大是继发创伤性凝血功能障碍的危险因素（P<0.05）；5项因素联合预测交通创伤患者继发创伤性凝血功能障碍的ROC曲线下面积为0.963，敏感度83.3%，特异度96.7%。结论入院时GCS低、Hb下降、ISS高、发生酸中毒及头颅CT复查血肿增大均是导致交通创伤患者继发创伤性凝血功能障碍的危险因素，且上述因素联合的预测价值较高。

关键词: 创伤和损伤, 危险因素, ROC曲线, 凝血功能障碍

Abstract:

Objective To investigate the risk factors of secondary traumatic coagulopathy in patients with traffic trauma. Methods A total of 122 patients with traffic trauma in Department of Emergency Surgery, the First Affiliated Hospital of Anhui Medical University (Dongcheng Hospital) from April 2022 to March 2023 were retrospectively collected. Patients were divided into the occurrence group (n=30) and the non-occurrence group (n=92). Body temperature, acidosis, hematoma enlargement after head CT examination, Glasgow coma score (GCS), trauma severity score (ISS), platelet count (PLT) and hemoglobin (Hb) at admission were collected and compared between the two groups. Multivariate Logistic regression was used to analyze risk factors of secondary traumatic coagulopathy in traffic trauma patients, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of related factors for secondary traumatic coagulopathy. Results The body temperature, GCS, PLT and Hb in the occurrence group were lower than those in the non-occurrence group, while the ISS, incidence of acidosis and the incidence of increased hematoma after CT examination were higher than those in the non-occurrence group (all P < 0.05). Multivariate Logistic regression analysis showed that low GCS, low Hb level, high ISS, acidosis and increased hematoma after head CT examination were risk factors at admission (P < 0.05). The area under ROC curve (AUC) of the five factors combined for secondary traumatic coagulopathy in traffic trauma patients was 0.963, sensitivity was 83.3% and specificity was 96.7%. Conclusion Decreased GCS and Hb on admission, high ISS, acidosis and increased hematoma during head CT review are risk factors for secondary traumatic cotting disorder in traffic trauma patients, and the combination of these factors has high predictive value.

Key words: wounds and injuries, risk factors, ROC curve, coagulation disorders

中图分类号:

R641

图/表 4

参考文献 19

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组别		n	男性	年龄/岁		体温/℃		入院时GCS/分		GOS/分		ISS/分		ASA分级≥Ⅲ级		低血压
未发生组		92	52（56.5）	58.74±20.25		37.02±0.21		11.27±1.28		2.52±1.76		18.21±2.28		13（14.1）		17（18.5）
发生组		30	16（53.3）	58.57±20.51		36.04±0.35		7.82±1.73		2.48±2.39		26.67±3.34		5（16.7）		7（23.3）
χ²或t			0.093	0.040		18.483^＊＊		11.703^＊＊		0.099		15.625^＊＊		0.116		0.337
组别	低血氧				酸中毒		头颅CT复查血肿增大		手术时间/h		术中出血量/mL		PLT/（×10⁹/L）		Hb/（g/L）
未发生组	30（32.6）				15（16.3）		12（13.0）		2.72±0.46		153.27±2.38		113.25±6.43		126.21±6.70
发生组	10（33.3）				19（63.3）		21（70.0）		2.68±0.57		152.32±2.74		102.74±5.38		89.25±5.63
χ²或t	0.005				24.891^＊＊		37.192^＊＊		0.389		1.808		8.069^＊＊		27.210^＊＊

组别		n	男性	年龄/岁		体温/℃		入院时GCS/分		GOS/分		ISS/分		ASA分级≥Ⅲ级		低血压
未发生组		92	52（56.5）	58.74±20.25		37.02±0.21		11.27±1.28		2.52±1.76		18.21±2.28		13（14.1）		17（18.5）
发生组		30	16（53.3）	58.57±20.51		36.04±0.35		7.82±1.73		2.48±2.39		26.67±3.34		5（16.7）		7（23.3）
χ²或t			0.093	0.040		18.483^＊＊		11.703^＊＊		0.099		15.625^＊＊		0.116		0.337
组别	低血氧				酸中毒		头颅CT复查血肿增大		手术时间/h		术中出血量/mL		PLT/（×10⁹/L）		Hb/（g/L）
未发生组	30（32.6）				15（16.3）		12（13.0）		2.72±0.46		153.27±2.38		113.25±6.43		126.21±6.70
发生组	10（33.3）				19（63.3）		21（70.0）		2.68±0.57		152.32±2.74		102.74±5.38		89.25±5.63
χ²或t	0.005				24.891^＊＊		37.192^＊＊		0.389		1.808		8.069^＊＊		27.210^＊＊

变量	β	SE	Wald χ²	P	OR（95%CI）
体温	-0.393	0.796	0.244	0.621	0.675（0.142~3.211）
入院时GCS	-0.719	0.259	7.692	0.006	0.487（0.293~0.810）
ISS	0.365	0.113	10.472	0.001	1.441（1.155~1.798）
酸中毒	2.092	0.797	6.894	0.009	8.098（1.699~38.591）
头颅CT复查血肿增大	3.576	1.064	11.294	<0.001	35.744（4.440~287.773）
PLT	0.023	0.053	0.191	0.662	1.023（0.923~1.135）
Hb	-0.075	0.032	5.700	0.017	0.927（0.872~0.987）
常数项	16.852	30.990	0.296	0.587	252.523

变量	β	SE	Wald χ²	P	OR（95%CI）
体温	-0.393	0.796	0.244	0.621	0.675（0.142~3.211）
入院时GCS	-0.719	0.259	7.692	0.006	0.487（0.293~0.810）
ISS	0.365	0.113	10.472	0.001	1.441（1.155~1.798）
酸中毒	2.092	0.797	6.894	0.009	8.098（1.699~38.591）
头颅CT复查血肿增大	3.576	1.064	11.294	<0.001	35.744（4.440~287.773）
PLT	0.023	0.053	0.191	0.662	1.023（0.923~1.135）
Hb	-0.075	0.032	5.700	0.017	0.927（0.872~0.987）
常数项	16.852	30.990	0.296	0.587	252.523

变量	AUC	95%CI	截断值	敏感度/ %	特异度/ %	约登指数
GCS	0.766	0.639~0.892	9.245分	70.0	90.2	0.602
ISS	0.767	0.663~0.871	21.550分	56.7	87.0	0.437
酸中毒	0.735	0.623~0.847	-	63.3	83.7	0.470
头颅CT复查血肿增大	0.785	0.680~0.890	-	70.0	87.0	0.570
Hb	0.693	0.563~0.824	110.785 g/L	70.0	87.0	0.570
5项联合	0.963	0.931~0.994	-	83.3	96.7	0.800