POSTTRAUMA COAGULATION AND FIBRINOLYSIS

被引:114
作者
GANDO, S [1 ]
TEDO, I [1 ]
KUBOTA, M [1 ]
机构
[1] SAPPORO CITY GEN HOSP,DEPT ANESTHESIOL,CHUO KU,SAPPORO 060,JAPAN
关键词
TRAUMA; COAGULATION; FIBRINOLYSIS; DISSEMINATED INTRAVASCULAR COAGULATION; HEAD INJURY; FIBRINOPEPTIDE; ANTIPLASMIN; PLASMINOGEN ACTIVATOR; ANTICOAGULANTS;
D O I
10.1097/00003246-199205000-00009
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: To determine the effects of disseminated intravascular coagulation (DIC) and head injury on posttrauma coagulation and fibrinolysis. Design: Case-control study. Setting: General ICU (tertiary care center) in a city hospital serving a population of 150 million people. Patients: Forty trauma victims: 15 with DIC; 25 without DIC. Interventions: Measurement of six types of coagulation and fibrinolytic molecular markers (fibrinopeptide A, fibrinopeptide B(beta-15-42), plasmin antiplasmin complex, D-dimer, tissue plasminogen activator antigen concentration, tissue plasminogen activator activity) immediately after trauma, 3 days later, and 6 days later. Anticoagulant treatment with gabexate mesilate at 1.45 +/- 0.06 mg/kg/hr. Measurements and Main Results: Fibrinopeptide A, fibrinopeptide B(beta-15-42), plasmin antiplasmin complex, and D-dimer showed high values immediately after trauma and exceeded normal activity for the first 6 days. When trauma was complicated with DIC, the molecular markers showed significantly higher values than those for non-DIC patients on all days. In the head-injured patients, such effect was not noted. Tissue plasminogen activator antigen concentration and tissue plasminogen activator activity were within a normal physiologic range of variation. By contrast, tissue plasminogen activator antigen concentration increased significantly after trauma in patients with DIC. When anticoagulant treatment was found effective, it caused a reduction in fibrinopeptide A. Conclusions: a) Fibrinolytic shut-down and its reactivation cannot be confirmed after trauma. b) Head injury does not lead to an increase in posttrauma coagulation or fibrinolytic activity. c) DIC enhances posttrauma coagulation and fibrinolytic activity and plasminogen activator inhibitor activity can be inferred in DIC patients. d) Increase in tissue plasminogen activator antigen concentration without tissue plasminogen activator activation may be a prognostic factor indicative of DIC and its chances of improvement, and fibrinopeptide A as an assessment criterion for the effectiveness of anticoagulant treatment.
引用
收藏
页码:594 / 600
页数:7
相关论文
共 29 条
  • [1] AOKI N, 1987, JPN J CLIN PATHOL, V35, P1275
  • [2] DIFFERENCES IN COAGULATION AND FIBRINOLYSIS AFTER TRAUMATIC AND SEPTIC SHOCK IN MAN
    BAGGE, L
    HAGLUND, O
    WALLIN, R
    BORG, T
    MODIG, J
    [J]. SCANDINAVIAN JOURNAL OF CLINICAL & LABORATORY INVESTIGATION, 1989, 49 (01) : 63 - 72
  • [3] BERGSDORF N, 1983, THROMB HAEMOSTASIS, V50, P740
  • [4] BLOMBACK M, 1985, SCAND J CLIN LAB INV, V45, P15
  • [5] THE ABBREVIATED INJURY SCALE, 1985 REVISION - A CONDENSED CHART FOR CLINICAL USE
    CIVIL, ID
    SCHWAB, CW
    [J]. JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1988, 28 (01) : 87 - 90
  • [6] THE INJURY SEVERITY SCORE REVISITED
    COPES, WS
    CHAMPION, HR
    SACCO, WJ
    LAWNICK, MM
    KEAST, SL
    BAIN, LW
    [J]. JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1988, 28 (01) : 69 - 77
  • [7] ELMES MJ, 1983, THROMB RES, V50, P591
  • [8] FRANCIS RB, 1987, J LAB CLIN MED, V110, P541
  • [9] THROMBIN INDUCTION OF PLASMINOGEN ACTIVATOR-INHIBITOR IN CULTURED HUMAN-ENDOTHELIAL CELLS
    GELEHRTER, TD
    SZNYCERLASZUK, R
    [J]. JOURNAL OF CLINICAL INVESTIGATION, 1986, 77 (01) : 165 - 169
  • [10] KAPSCH DN, 1984, SURGERY, V95, P473