【摘要】 目的 探讨早期凝血功能障碍的严重多发伤患者血浆活化蛋白C(APC)、血清炎症因子白细胞介素-6(IL-6)及IL-10在受伤后不同时间点的动态变化规律及其临床意义。方法将40例多发伤患者根据其入院时凝血功能是否正常分为凝血障碍组20例与凝血正常组20例,10例健康体检者为正常对照组。分别于入院后12 h内、24 h、48 h及72 h,采用酶联免疫吸附法(ELISA)检测血浆APC和血清IL-6、IL-10含量,观察其动态变化。并比较两组患者机械通气时间、ICU住院时间、28 d病死率及第5天脓毒症并发率。结果 多发伤患者在入院时APC含量均明显升高,而凝血障碍组患者APC含量持续偏高,凝血正常组患者APC有逐渐下降趋势,在48、72 h明显下降(P<0.05),凝血障碍组患者APC含量各时间点均较凝血正常组明显升高(P<0.05)。入院第5天凝血障碍组的脓毒症并发率明显高于凝血正常组(P<0.05)。多发伤患者凝血障碍组及凝血正常组的血清IL-6、IL-10含量在入院12 h内、24 h、48 h及72 h均较健康对照组明显升高(P<0.05),而其中凝血障碍组患者在受伤后12 h内、24 h、48 h及72 h血清IL-6、IL-10含量均较凝血正常组明显升高(P<0.05)。其中凝血障碍组患者在入院48 h及72 h血清IL-6、IL-10含量与入院24 h比较有下降趋势(P<0.05)。结论 早期凝血障碍的多发伤患者易并发脓毒症,其APC及炎症因子的测定有利于评估病情并预测感染的发生。更多还原

【Abstract】 Objective To investigate the dynamic changes and its clinical significance of activated protein C(APC),IL-6 and IL-10 in the severe trauma patients with the early change of blood coagulation.Methods Forty patients with severe multiple trauma were divided into coagulation disorder group(20 patients) and coagulation normal group(20 patients).In addition,the healthy control group was set up in the healthy physical examination people.The level of APC,IL-6 and IL10 were respectively detected by double-antibody sandwich enzyme-linked immunosorbent assay(ELISA).The dynamic changes were observed within 12 hours of injury and 24 hours,48 hours,72 hours after injury.The 28-day mortality,ICU hospital stays,ventilation duration and sepsis incidence were compared between the two groups.Results Compared with normal controls,the level of plasma APC was significantly increased in patients with severe multiple trauma.The levels of plasma APC were significantly increased in patients coagulation disorder group.The levels of plasma APC declined gradually in coagulation normal group and reached significantly lower levels in 48 hours and 72 hours after injury compared with coagulation normal group(P <0.05).Compared with healthy control group, the levels of serum IL-6 and IL-10 were significantly increased in patients with severe multiple trauma(P<0.05).Compared with coagulation normal group,the levels of serum IL- 6 and IL- 10 were significantly increased in coagulation disorder group within 12 hours of injury and 24 hours,48 hours,72 hours after injury(P < 0.05).The levels of serum IL- 6 and IL-10 declined gradually in 48 hours and 72 hours after injury compared with the levels in 24 hours of injury in the coagulation normal group(P < 0.05) Conclusion The sepsis is more frequent in coagulation disorders with severe multiple trauma.It is very clinical meaningful to assess the prognosis and to evaluate its development by measuring the levels of APC,IL-6 and IL-10.更多还原