Bríza J, Kudrna K, Kvasnicka J, Busta O, Trca T
I. chirurgická klinika 1. lékarské fakulty Univerzity Karlovy a Vseobecné fakultní nemocnice, U Nemocnice 2, 128 08 Praha 2, Czech Republic.
Sb Lek. 2002;103(2):193-202.
This study observes acute phase response in first time after injury.
Injured patients are already in first timepiece up severe injury in worse general state developed acute phase response than control group before planed surgery. Levels of indicators acute phase response and haemostasis from venous blood samples collected in an injury day and at patients control group before planned surgery were compared. We compare findings of traumatized in admission day and of patients at 6th-7th day after planned surgery, when is the biggest handicap. Plasma levels of orosomukoid, C reactive protein, prealbumin, transferin, alpha-2-macroglobulin, PAI-1, tPA, sE-Selectin, SICAM, sP-Selectin, antithrombin III, fibrinogen, haemoglobin, time of Quick test, TT, APTT, number of leukocytes, erythrocytes and thrombocytes were determined.
Tested group severe injured admitted in I. Surgical Department of First Medical School of Charles University and General Faculty Hospital in Prague in years 1995-1998 (n = 105) be characterized by average value ISS--19.182 +/- 3.315, PTS--28.284 +/- 2.362, AIS--6.739 +/- 0.829 and GCS--11.449 +/- 0.974 and average age 56.89 +/- 4.84 year. Average time hospitalization was 70 days. Between 7th-21st day of hospitalization 23 patients dead on multiorgan failure or sepsis. Control patient file before planned surgery (n = 50) and after planned surgery (n = 33) was comparable in age characteristics.
Adaptation reserve of injured is already in first time-piece since injury significantly lower to patients without trauma. Starting position traumatized patients before acute surgery is comparable with state of patients at 6th-7th day after planned surgery, when culminates postoperative acute phase response.
本研究观察损伤后首次出现的急性期反应。
受伤患者在计划手术前，相较于对照组，在更差的一般状态下因严重损伤首次出现急性期反应。比较了在受伤当天和计划手术前从患者静脉血样本中采集的急性期反应指标和止血指标水平。我们比较了入院当天创伤患者和计划手术后第6 - 7天患者的结果，此时是最大障碍期。测定了血浆中类粘蛋白、C反应蛋白、前白蛋白、转铁蛋白、α - 2 -巨球蛋白、PAI - 1、tPA、sE -选择素、SICAM、sP -选择素、抗凝血酶III、纤维蛋白原、血红蛋白、Quick试验时间、TT、APTT、白细胞、红细胞和血小板数量。
1995 - 1998年在布拉格查理大学第一医学院和综合大学医院第一外科收治的重度受伤试验组患者（n = 105），其平均损伤严重度评分（ISS）为19.182 ± 3.315，创伤严重度评分（PTS）为28.284 ± 2.362，简明损伤定级（AIS）为6.739 ± 0.829，格拉斯哥昏迷评分（GCS）为11.449 ± 0.974，平均年龄为56.89 ± 4.84岁。平均住院时间为70天。住院第7 - 21天，23例患者死于多器官功能衰竭或败血症。计划手术前的对照患者档案（n = 50）和计划手术后的对照患者档案（n = 33）在年龄特征方面具有可比性。
自受伤起，受伤患者的适应储备首次显著低于未受伤患者。急性手术前创伤患者的起始状态与计划手术后第6 - 7天患者的状态相当，此时术后急性期反应达到高峰。
