危重症患者肾功能与凝血功能变化的关系  

Relationship Between Renal Function and Blood Coagulation in Critical Patients

作　　者：潘景业[1] 王明山[1] 王国印[1] 陈波[1] 陈洁[1] 

机构地区：[1]温州医学院附属第一医院,温州325000

出　　处：《中国中西医结合肾病杂志》2005年第4期216-218,共3页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：浙江省教育厅科研基金资助项目 (No .2 0 0 410 5 6)

摘　　要：目的:探讨危重症患者肾功能与凝血功能变化关系。方法:通过检测危重症患者肾功能(Scr和BUN)和凝血功能指标(TT、PT、APTT、PLG、FIB、Ⅷ:C、ATⅢ、VWF、D -D和3P试验) ,根据血肌酐值分为正常组(N组,Scr <130 μmol/L)和血肌酐异常组(A组,Scr≥130 μmol/L) ,采用t检验分析两组凝血功能各项指标差异。结果:在全部6 3例入选病例中,有2 7例发生急性肾衰竭(acuterenalfailure,ARF) ,确诊弥散性血管内凝血(disseminatedintravas cularcoagulation ,DIC)有10例。3P试验阳性率N组为1.7% ,A组为12 .7% ,A组显著高于N组。A组PT明显延长,与N组比较有统计学差异(P <0 .0 1)。FIB、PLG和ATⅢ明显下降,D -D升高,与N组比较有统计学差异(P <0 .0 1)。Ⅷ:C和VWF均较正常高值显著升高。与N组比较,A组Ⅷ:C轻度降低,VWF轻度升高,但均无统计学差异(P >0 .0 5 ) ,而A组Ⅷ:C/VWF比值明显降低,有统计学差异(P <0 .0 1)。结论:危重症患者发生ARF时,常合并凝血功能的异常,凝血功能异常可能参与了ARF的进展。Objective:To investigate the changes of renal and blood coagulation functions in critical patients.Methods:Renal function (Scr and BUN) and coagulation function(TT,PT,APTT,PLG,FIB, Ⅷ:C,ATⅢ,VWF,D-D and 3P-test) were measured in critical patients. According to the serum creatinine value, the critical patients were divided into 2 groups, normal control(Group N, Scr<130 μmol/L) and abnormal group (Group A,Scr≥130 μmol/L).Parameters of coagulation function were compared between the two groups by t-test.Results:Acute renal failure occurred in 27 cases and disseminated intravascular coagulation(DIC) occurred in 10 cases of all 63 selected cases. The positive rate of 3p-test was 1.7% for Group N and 12.7% for Group A with significant difference. PT in Group A was significant longer than that in Group N(P<0.01). FIB, PLG and ATⅢ in Group A significantly decreased and D-D increased with significant statistical difference(P<0.01). Ⅷ:C slightly decreased and v WFA slightly increased in Group A but without significant difference between the two groups(P>0.05).The ratio of Ⅷ:C/v WF in Group A significantly decreased with a significant difference (P<0.01).Conclusion:Coagulation function becomes abnormal when critical patients are complicated with acute renal failure. Abnormal coagulation may be involved in the progression of acute renal failure.

关 键 词：急性肾功能衰竭 肾功能 凝血功能 血肌酐异常 

分 类 号：R446.1[医药卫生—诊断学]