目的:探讨西宁地区严重创伤患者发生弥漫性血管内凝血(DIC)特点,并提出相应的治疗方法。方法:分析20例DIC患者的实验室指标:包括凝血酶原时间(PT)、白陶土部分凝血酶原时间(KPTT)、凝血酶时间(TT)、纤维蛋白原(FBG)、D-Dimer试验(D-D)和血小板(PLT)计数和临床表现,并进行急性生理与慢性健康指标(APACHEⅡ)评分,脏器衰竭数目评定,提出治疗对策。治疗原发病,支持脏器功能,补充凝血因子,早期使用小分子肝素是治疗的关键。结果:20例DIC中,成活14例,死亡6例。20例患者在第一天均出现DIC指标的异常,每个病人脏器衰竭的数目都在2个以上,两组差别两者无统计学意义(P>0.05);成活组APACHEⅡ评分为(26.1±8.48)分,死亡组为(26.5±8.56)分,两组差别两者无统计学意义(P>0.05);20例病人经过治疗7天后,死亡组患者DIC指标明显恶化,6例患者均出现PLT明显下降,D-Dimer明显升高,同时FBG明显降低,PT、APTT继续延长,而成活组仅有5例上述指标异常,两组比较差别两者有统计学意义(P<0.01),同时,成活组APACHEⅡ评分下降为(17.6±5.7)分,而死亡组为(28.6±6.1)分,两组比较差别两者有统计学意义(P<0.01);死亡组器官衰竭数目均达到4个以上,而成活组存在3个器官衰竭的仅5例,两组比较差别两者有统计学意义(P<0.05)。结论:严重创伤患者易并发DIC,尤其在高海拔地区,积极治疗原发病,加强受损器官的监测与支持,并及时应用低分子肝素,会明显提高抢救成活率。 Objective: To investigate the characteristics of diffuse intravascular coagulation (DIC) in patients with severe trauma in Xining area and to propose corresponding treatment methods. Methods: The laboratory data of 20 patients with DIC were analyzed including PT, KPTT, TT, FBG, D-Dimer test (DD), platelet count (PLT) and clinical manifestations. The scores of Acute Physiology and Chronic Health Index (APACHEⅡ) and the number of organ failure were evaluated and the treatment strategies were proposed. Treatment of primary disease, support organ function, complement coagulation factors, the early use of small molecular weight heparin is the key to treatment. Results: Of the 20 DICs, 14 survived and 6 died. There were more than 2 DIC index in each of the 20 patients on the first day, and the number of organ failure in each patient was more than two. There was no significant difference between the two groups (P> 0.05). APACHEⅡ score in the survival group was (26.1 ± 8.48) in the death group and (26.5 ± 8.56) in the death group, respectively. There was no significant difference between the two groups (P> 0.05). After the treatment of 20 patients for 7 days, the DIC index in the death group was significantly deteriorated. There was a significant decrease in PLT, D-Dimer was significantly increased, while FBG was significantly lower, PT, APTT continued to extend, and only 5 cases of survival of the above indicators abnormalities, the difference between the two groups was statistically significant (P <0.01) At the same time, APACHEⅡscore decreased to (17.6 ± 5.7) points in the survival group and (28.6 ± 6.1) points in the death group, the difference between the two groups was statistically significant (P <0.01); the number of organ failure in the death group reached 4 There were only 5 cases of survival failure in 3 organ failure group, the difference between the two groups was statistically significant (P <0.05). Conclusions: Patients with severe traumatic injury are prone to complicated with DIC, especially in high altitude areas. Active treatment of primary disease, monitoring and support of damaged organs, and timely application of LMWH can obviously improve the survival rate of rescue.