乌司他丁和氨甲环酸对严重创伤早期凝血功能的影响

摘要

Objective To investigate the effect of ulinastatin and tranexamic acid on the coagulation function in early severe trauma.Methods A total of 174 cases with early severe trauma was divided into three groups.The patients in groups of A(54 cases) and B(58 cases) were given ulinastatin 500000 units and tranexamic acid 1.0 g,respectively,as well as plasma 600 ml.The patients in group C(62 cases) were given ulinastatin 500000 units,tranexamic acid 0.75 g and plasma 600 ml.A repeated dose of ulinastatin 500000 units was injected at three hours later in groups of A and C.The levels of prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fg),thrombomodulin(TM) and protein C were detected on admission and on the 3rd,24th hour and 5th day after treatment.The outcomes of treatment were observed and compared among three groups.Results The times of PT and APTT were shorter in group B than those in group A on the 3rd hour after treatment(P<0.05).The level of protein C was higher in group C than that in groups of A and B on the 3rd hour after treatment(P<0.05).The times of PT and APTT were shorter in group C than those in groups of A and B on the 3rd and 24th hour after treatment(P<0.05).The level of Fg was higher and TM was lower in groups of B and C than those in group A on the 3rd and 24th hour after treatment,which were changed more obviously in group C(P<0.05).The percentages of the cases with better recovery and less mortality and long term hospital stay were higher in group C than those in groups of A and B(P<0.05).Conclusion Combined use of ulinastatin and tranexamic acid in patients with severe trauma in early stage can improve the coagulation function and success rate of treatment.%目的 探讨乌司他丁和氨甲环酸对严重创伤早期凝血功能的影响.方法 严重创伤早期患者174例,分为三组:乌司他丁组54例,入院时给予乌司他丁50万单位及血浆600ml,3h后重复乌司他丁50万单位;氨甲环酸组58例,入院时给予氨甲环酸1.0g及血浆600ml;联合组62例,入院时给予乌司他丁50万单位、氨甲环酸0.75g以及血浆600ml,3h后重复乌司他丁50万单位.于入院时、治疗3h、24h和5d检测凝血酶原时间(PT)、APTT、纤维蛋白原(Fg)、血栓调节蛋白(TM)和蛋白C水平,观察三组治疗结果.结果 治疗3h,氨甲环酸组PT和APTT较乌司他丁组缩短(P<0.05),联合组蛋白C较其他两组升高(P<0.05).治疗3h和24h,联合组PT和APTT较其他两组缩短(P<0.05),氨甲环酸组和联合组Fg较乌司他丁组升高,TM较乌司他丁组降低,联合组较氨甲环酸组改善更明显(P<0.05).联合组较乌司他丁组和氨甲环酸组康复比例高,死亡和长期住院比例低(P<0.05).结论 严重创伤早期,联合应用乌司他丁和氨甲环酸能够更好地改善患者的凝血功能,提高救治成功率.