The Influence Factors And Clinical Significance Of Acute Traumatic Coagulopathy

Each year the number of deaths from trauma in more than 3 million, including more than 1 million people died in the number of traffic accidents, traffic accident is the world’s ninth largest cause of death, in 2020 is expected to rise to the third, and the traffic accident death in patients with a third of the cause of death for massive hemorrhage.Trauma patients with early the main causes of death were hemorrhage,the latter is mainly the severe craniocerebral injury, sepsis and multiple organ dysfunction syndrome.Trauma hemorrhage is not simply disposal of blood loss, it is need to traumatic hemorrhage caused by a series of pathophysiological changes and the multiple organ dysfunction caused by the comprehensive disposal, so as to improve the patient’s mortality.Acute traumatic coagulopathy refers to the trauma due to massive bleeding and tissue damage after activation of coagulat- ion,fibrinolysis, anticoagulant pathway, in acute early coagulation function disorder. ATC in high occurrence of severe trauma patients, often progress for the merger of hypothermia, acidosis, the "Lethal triad".The three interactions, once a vicious cycle, after the terrible, led to the deaths of patients. According to statistics,the world every year the number of people killed by trauma accounted for 10% of all deaths, while the 30%-40% of deaths from trauma is due to the complicated ATC. In the super acute period after severe trauma, blood coagulation dysfunction can be detected, understanding of the relationships between ATC and multiple trauma treatment and prognosis have important clinical significance.Trauma induced coagulopathy is the most dangerous patients with severe trauma is one of the most common complications, blood coagulation dysfunction as the main clinical features, is an important factor, which could lead to an increase in mortality of patients with obvious, at the same time, the prognosis of patients with severe trauma also will be affected by low temperature and severity of injury, acidosis, and other factors.The occurrence of a positive correlation between the severity of traumaand trau- matic coagulopathy in patients with severe multiple trauma, near 1/3 in the injured after early traumatic coagulopathy in different degree,is an independent risk factor of death after trauma. In the United States, the high level in patients with trauma center for a high incidence of traumatic coagulopathy, 2/3 in the ISS > 45 patients have serious blood coagulation disorders, trauma emergency room for the first time in early detection of prothrombin time(PT) is higher than 14 seconds indicates that the mortality rate is as high as 35%, activated partial thromboplastin time have better prediction effect. ATC progress rapidly, studies show that up to 25%- 35% of patients in the existed arrived at the emergency room with acute blood coagulation dysfunction. Blood loss deaths accounted for 40% of trauma patients early mortality, if at the same time with coagulopathy, the case fatality rate will be increased by 4 times, incidence of survivors of trauma hemorrhage also increased significantly. A large number of observational studies have found that ATC is prolonged coagulation time,independent predictors can be used as multiple organ failure, sepsis complications and intensive care.In this paper, a retrospective analysis of 1490 patients with multiple injury in the third hospital of hebei medical university from January 2013 to December 2013 admitted to the cases, which conforms to the traumatic blood coagulation patients 90 cases as the research object, Retrospective analysis of the patient’s general information, determination of blood routine, coagulation index, biochemical index, arterial blood p H value, base excess(BE) and record the patient injury severity score(ISS), acute physiology and chronic health evaluation(APACHEⅡ), Glasgow coma scale(GCS), To study the relationship between coagulopthy and prognosis of various factors to improve the level of treatment of trauma induced coagulopathy.Objective: To investigate the risk the prognosis of patients with acute traumatic coagulopathy factors, and further enhance the understanding of traumatic coagulopathy and analyzes its influence on prognosis.Methods: A retrospective analysis of 1490 patients with multiple injury in our hospital from January 2013 to December 2013 admitted to the cases, which conforms to the traumatic blood coagulation patients 90 cases as the research object, Record the patient’s sex, age, injury severity score(ISS), acute physiology and chronic health evaluation(APACHE Ⅱ), Glasgow coma scale(GCS),determination of blood routine, coagulation index, biochemical index. According to whether the patients with shock, acidosis, hypothermia and presence of complicated with multiple organ dysfunction syndrome(MODS), and compare the survival rate and mortality. Application of Logistic regression analysis of various factors and trauma induced coagulopathy prognosis and the relationship between the blood coagulation disorder.Results: 90 cases of patients with traumatic coagulopathy, survival group 62(68.9%) and death group 28(31.1%).1 The time form injure to emergency room and the time of deathThe time from onset patients mainly concentrated in 14 hours, the time of death is mainly in 10 days.2 The influence of sex, age, ISS, APACHEⅡ,GCS on the prognosisCompared with survival group, death group in ISS score(36.86±6.74), APACHE Ⅱscore(21.86±8.30), GCS score(8.57±5.73) on prognosis was statistically significant(P<0.05).The prognosis of patients with sex(male 60.7%、female 39.3%), age(40.89±13.59)of no statistical significance(P>0.05).3 The causes of injury and the main sites of injuryAnatomical injury reason and injury parts and has no impact on whether coagulopathy after admission, no statistical significance(P>0.05).4 The influence of blood routine(PLT),coagulation index(PT、APTT、INR),base excess(BE)on the prognosisCompared with survival group, death group in PLT(70.93±39.32)、PT(23.26±5.37)、APTT(60.99±26.14)、INR(2.08±0.60)、BE(13.33±7.30)on prognosis was statistically significant(P<0.05).5 The influence of shock, acidosis, hypothermia and multiple organ dysfunction syndrome(MODS)on the prognosisCompared with survival group, death group in shock 19(67.9%), acidosis 16(57.1%), hypothermia 14(50.0%),MODS 20(71.4%) on prognosis was statistically significant(P<0.05).6 The influence of the complications90 patients in the concurrent electrolyte disorder in 9 cases, among which 4(6.5%) were survival group and death group in 5(17.9%).Stress ulcer in 3 cases,among which 1(1.6%) were survial group and death group in 2(7.1%).Acute renal failure in 2 cases,among which 0(0.0%) were survial group and death group in 2(7.1%).Compared with survival group, death group in electrolyte disorder,Stress ulcer on prognosis was no statistically significant(P>0.05). Acute renal failure on prognosis was statistically significant(P<0.05).7 The influence of ventilator on prognosis90 patients in the ventilator in 49 cases, among which 21 were survival group and death group in 28. Application of 49 cases with ventilator patients, compare the respirator time: survival group 4.62 ±4.22 days, the death group was 6.64±5.77 days, there was no statistically significant(P>0.05).8 Logistic regression analysisISS score, BE correlated with trauma induced coagulopathy and there was statistically significant, the influence factors the prognosis of ATC patients.Conclusions: Abnormal blood coagulation indexes help predict progression of multiple trauma patients.Combined with shock, hypothermia, acidosis and concurrent MODS increased significantly mortality.Monitoring of ISS score, BE helps to evaluate the onset blood coagulation function and early treatment, has very important meaning for the patient’s condition, judge successful diagnosis and treatment of multiple trauma patients.