严重多发伤患者血浆F1+2、D-二聚体水平的变化及与弥散性血管内凝血的关系

目的 探讨严重多发伤患者血浆凝血酶原片段(F1+2)、D一二聚体水平变化及与创伤后弥散性血管内凝血(DIC)之间的关系. 方法 将66例多发伤患者分为轻伤组(ISS＜16分)21例和重伤组(ISS≥16分)45例,再把重伤患者分为并发DIC组(12例)与未并发DIC组(33例).另10例健康人设为正常对照组.正常对照组采外周静脉血1次,其余组分别于伤后1、3、7d空腹采集外周静脉血,应用ELISA方法测定血浆F1+2浓度,全自动乳胶微粒增强免疫比浊分析方法测定血浆D一二聚体浓度. 结果 轻伤与重伤组血浆F1+2、D-二聚体水平伤后均明显高于正常对照组,且重伤组又明显高于轻伤组.非DIC组伤后F1+2、D-二聚体水平逐渐降低,DIC组F1+2、D-二聚体水平持续升高并显著高于非DIC组.血浆F1+2、D-二:聚体水平在伤后1、3、7 d均呈明显的正相关. 结论 创伤后急性期F1+2、D-二聚体水平的升高程度不仅与创伤严重程度有关,而且与创伤后DIC的发生密切相关.因此,测定严重多发伤患者急性期外周血浆F1+2、D-二聚体水平变化对早期预测创伤后DIC的发生具有一定价值.

Changes of plasma F1+2,D-dimer levels in multiple trauma patients and their relations with disseminated intravascular coagulation

Objective To observe changes of plasma thrombinogen segment 1+2(FI+2)and D-dimer(D-D)in multiple trauma patients and exphlore their relations with traumatic disseminated intra-vascular coagulation(DIC). Methods A total of 66 multiple trauma patients were divided into minor injury group(ISS＜16 points,21 patients)and severe multiple trauma group(ISS≥16 points,45 pa-tients).Then.severe multiple trauma group were divided into DIC group(12 patients)and non-DIC group(33 patients).Another 10 healthy pemons were served as control group.Venous blood was collect-ed once in the control group and that collected from other groups at days 1,3 and 7 after injury.The F1 +2 concentrarion was detetrained with ELISA.and the D-D concentration was measured by automated la-tex enhanced immunoassay. Results The F1+2 and D-D levels in the minor injury group and sever multiple trauma group were both higher than that of the control group.In the meantime.the F1+2 and D-D levels in severe injury group were remarkably higher than that in the minor injury group.The plasma F1 +2 and D-D levels were elevated continuously in traumatic DIC group and remarkably higher than that in the non.DIC group.in which the plasma F1+2 and D-D levels gradually declined.Plasma F1+2 and D-D levels had significantly positive correlations at days 1,3 and 7 after injury. Conclusions Hiigher levels of F1+2 and D.D at acute stage is not only relevant to the injury severity,but also closely to the occurrence of traumatic DIC after injury.Detection of plasma F1+2 and D-D levels may play an impor-taut role in early prediction of DIC.