严重创伤儿童的创伤诱导凝血因子耗竭：一项单中心观察性研究。
Trauma induced clotting factor depletion in severely injured children: a single center observational study.
机构信息
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
Department of Orthopedics and Trauma Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
出版信息
World J Emerg Surg. 2020 May 6;15(1):31. doi: 10.1186/s13017-020-00311-6.
BACKGROUND
Coagulopathy following severe trauma contributes significantly to mortality. Impaired clotting factors have been observed in adult trauma patients, but in pediatric trauma victims their activity has not yet been investigated.
METHODS
Sixteen pediatric trauma patients were evaluated according to the ISS and assigned to two cohorts. An additional control group (CO; n = 10) was formed. Routine coagulation parameters and the soluble clotting factors (F) were tested. Nonparametric data was analyzed using the Mann-Whitney U test. Results are reported as median and interquartile range.
RESULTS
The ISS of severely (SI, n = 8) and mildly (MI, n = 8) injured children differed significantly (25 [19-28] vs. 5 [4-6]; p < 0.001). INR was elevated in the SI cohort only when compared to the CO (1.21 [1.04-1.58] vs. 0.96 [0.93-1.00]; p = 0.001). Differences between SI and MI were found for FII (67 [53-90] vs. 82 [76-114] %; p = 0.028), FV (76 [47-88] vs. 92 [82-99] %; p = 0.028), and FXIII (67 [62-87] vs. 90 [77-102] %; p = 0.021). Comparison of the SI with the CO (FII 122 [112-144] %; p < 0.001; FV 123 [100-142] %; p = 0.002; and FXIII 102 [79-115] %; p = 0.006) also revealed a reduction in the activity of these factors. Furthermore, fibrinogen (198 [80-242] vs. 296 [204-324] mg/dl; p = 0.034), FVII (71 [63-97] vs. 114 [100-152] %; p = 0.009), FIX (84 [67-103] vs. 110 [90-114] %; p = 0.043), and FX (70 [61-85] vs. 122 [96-140] %; p = 0.001) were reduced in the SI in comparison with the CO. Finally, FVIII was considerably, yet not significantly, increased in both patient cohorts (235 [91-320] % and 197 [164-238] %, respectively).
CONCLUSIONS
This study proves that children suffer a depletion of clotting factors following severe injury which basically reflects the findings for adult trauma patients. Attempts to correct the impaired clotting factor activity could be based on a specific hemostatic therapy involving administration of coagulation factors. Nevertheless, therapeutic implications need to be investigated in future studies.
背景
严重创伤后出现的凝血功能障碍是导致死亡率升高的主要原因之一。在成年创伤患者中已经观察到凝血因子受损，但在儿科创伤患者中，其活性尚未得到研究。
方法
根据 ISS 对 16 名儿科创伤患者进行评估，并将其分为两组。还组建了一个额外的对照组（CO；n = 10）。测试了常规凝血参数和可溶性凝血因子（F）。使用曼-惠特尼 U 检验对非参数数据进行分析。结果以中位数和四分位距表示。
结果
严重（SI，n = 8）和轻度（MI，n = 8）受伤儿童的 ISS 差异显著（25 [19-28] vs. 5 [4-6]；p < 0.001）。仅与 CO 相比，SI 组的 INR 升高（1.21 [1.04-1.58] vs. 0.96 [0.93-1.00]；p = 0.001）。SI 和 MI 之间存在 FII（67 [53-90] vs. 82 [76-114] %；p = 0.028）、FV（76 [47-88] vs. 92 [82-99] %；p = 0.028）和 FXIII（67 [62-87] vs. 90 [77-102] %；p = 0.021）的差异。与 CO 相比，SI 的比较（FII 122 [112-144] %；p < 0.001；FV 123 [100-142] %；p = 0.002；和 FXIII 102 [79-115] %；p = 0.006）也显示这些因子的活性降低。此外，纤维蛋白原（198 [80-242] vs. 296 [204-324] mg/dl；p = 0.034）、FVII（71 [63-97] vs. 114 [100-152] %；p = 0.009）、FIX（84 [67-103] vs. 110 [90-114] %；p = 0.043）和 FX（70 [61-85] vs. 122 [96-140] %；p = 0.001）在 SI 中均低于 CO。最后，VIII 因子在两个患者组中都显著增加（分别为 235 [91-320] %和 197 [164-238] %），尽管差异无统计学意义。
结论
本研究证明儿童在严重创伤后会出现凝血因子耗竭，这基本上反映了成年创伤患者的发现。尝试纠正受损的凝血因子活性可以基于涉及凝血因子给药的特定止血治疗。然而，治疗意义需要在未来的研究中进行调查。
Zotero 插件