多器官功能不全综合征患者凝血功能的变化及临床意义  

Evaluation of coagulation functions in patients with multiple organ dysfunction syndrome

作　　者：陈晓辉[1] 熊旭明[1] 罗辉遇[1] 谢长江[1] 温德良[1] 刘卫江[1] 江慧玲[1] 李昭骥[1] 

机构地区：[1]广州医学院第二附属医院,广东广州510260

出　　处：《中国急救医学》2005年第3期188-189,共2页Chinese Journal of Critical Care Medicine

摘　　要：目的　研究多器官功能不全综合征 (MODS)患者凝血功能的变化 ,并对其临床意义进行探讨。方法　 4 7例MODS患者被列为观察对象 ,其中 15例符合DIC诊断标准。测定血浆抗凝血酶 -Ⅲ (AT -Ⅲ )、凝血酶原时间 (PT)、活化部分凝血活酶时间 (APTT)、纤维蛋白原 (Fg)、D -二聚体和血小板计数 (Plt) ,同时计算患者的急性生理和慢性健康评分 (APACHEⅡ )。 2 0例健康体检者为正常对照。结果　MODS组血浆AT -Ⅲ和D -二聚体与正常对照组有显著差异 (P <0 .0 1) ;DIC组与非DIC组之间无明显差异。MODS组血浆PT、APTT和Fg与对照组无显著差异 ,Plt则有显著性差异 (P <0 .0 1) ;DIC组与非DIC组比较 ,PT、APTT、Fg和Plt有差异有显著性 (P <0 .0 1)。MODS患者血浆AT -Ⅲ与APACHEⅡ评分呈负相关 ,相关系数r= - 0 .782 ,P <0 .0 1。结论　AT -Ⅲ在MODS的发病过程中起着重要的作用 ;血浆AT -Ⅲ水平是反映MODS患者预后的指标 ;血浆AT -Ⅲ和D -二聚体水平不能作为MODS患者是否合并DIC的实验室指标。Objective To observe the changes of coagulation functions in patients with multiple organ dysfunction syndrome(MODS) and to discuss its clinical effect. Methods A total of 47 cases with MODS in intensive care unit were studied. Among 47cases, fifteen cases were diagnosed as disseminated intravascular coagulation (DIC). The antithrombin III(AT-III), prothrombin time(PT), activated partial thromboplastin time (APTT), fibrinogen(Fg), D-dimer,platelet count(PLT) and APACHE II score in patients with MODS were measured. A total of 20 cases health volunteers were taken as the control. Results The plasma concentrations of AT-III and D-dimer in patients with MODS were significantly different from control group (P<0.01). There was no significant difference between DIC group and non DIC group (P>0.05). The plasma concentrations of APTT, PT and Fg in patients with MODS had no significant difference from control group (P>0.05). There was significantly different between DIC group and non DIC group (P<0.01). The PLT in patients with MODS were significantly lower (P<0.01), which was also significantly different between DIC group and non DIC group (P<0.01). The plasma concentrations of AT-III was negative correlative with APACHE II score( r=-0.782, P<0.01). Conclusions AT-III might play an important role in pathogenesis of MODS. The plasma concentrations of AT-III were correlative with the degree of MODS, which may reflect prognosis of patients with MODS. The plasma concentrations of AT-III and D-dimer were not a diagnosis criterion of DIC in patients with MODS.

关 键 词：多器官功能不全综合征 抗凝血酶-Ⅲ 急性生理和慢性健康评分 预后 

分 类 号：R446.1[医药卫生—诊断学]