急性脑卒中全身炎症反应综合征凝血功能紊乱的临床研究  

Clinical Study on Coagulation Dysfunction in Acute Stroke with Systemic Inflammatory Response Syndrome

作　　者：杨宁[1] 薄蜀湘[1] 高聪[1] 

机构地区：[1]广东省广州医学院第二附属医院神经内科,510260

出　　处：《实用全科医学》2006年第4期383-384,共2页Applied Journal Of General Practice

摘　　要：目的探讨急性脑卒中全身炎症反应综合征(SIRS)凝血功能的变化及其临床指导意义。方法选取符合SIRS诊断标准的急性脑卒中252例,入院后24h内进行修订的Rankin量表评分,并采血测定凝血酶原时间(PT)、凝血酶时间(TT)、部分活化凝血活酶时间(APTT)、D-二聚体(DD)和血小板(PLT)计数等涉及到与凝血功能有关的实验室指标。分别以SIRS符合项数、预后及疾病严重程度分组,观察SIRS符合项目数与凝血功能紊乱间的关系,以及凝血功能在存活组与死亡组、危重症组与非危重症组之间的变化。结果随着SIRS符合项数的增加,危重病例所占百分比及病死率也明显增高,PT、TT、APTT、DD亦增高,具有明显的相关性,但PLT与SIRS符合项数间无明显相关性。存活组与死亡组之间PT、TT、APTT差异无显著性(P>0.05),死亡组DD显著高于存活组(P<0.01)。危重组的PT、TT、APTT、DD高于非危重组(P<0.01)。结论急性脑卒中SIRS存在明显的凝血机制的变化,形成复杂的全身性炎症/凝血反应。符合SIRS诊断标准项数越多,病情越重,凝血功能紊乱就越显著,预后愈差,病死率也越高。SIRS应早期干预,阻断SIRS的发展,防止DIC的发生,可降低危重急性脑卒中病死率。Objective To study the changes of coagulation function and its clinical significance in acute stroke with systemic inflanmatory response syndrome （SIRS）. Methods Two hundred and fifty two cases of acute stroke with SIRS were scored by Rankin standard for stroke within 24 hours after the admission. The laboratory indes related to coagulation function, such as prothrombin time （PT）, thrombin time （TT）, activated partial thromboplastic time （APTT） and D-dimer （DD） level and platelet counts （PLT） were detemined. The relation between the items according to SIRS and the coagulation function disorder was observed. The coagulation function in the survival group and death group, critical group and non critical group, was compared. Results The percentage of critical cases and mortality rate in SIRS acute stroke increased with increasing items of criteria for diagnosis of SIRS, so did the PT, TT, APTT and DD level. The PT, TT, APTT and DD levels remarkably correlated with the items, while there was not a correlation between PLT counts and the items. There was no difference in the PT, TT, APTT level between the survival group and the death group （P 〉0.05）, while plasma levels of DD in death group was signifi cantly higher than that in survival group （P 〈 0.01 ）. The PT, TT, APTT and DD levels in critical group was higher than that in the non critical group （P〈 0.01 ）. Conclusions There was an activation of the coagulation system in the acute stroke with SIRS. The inflanmmation and coagulation were closely linked and interwoven. The more items of the diagnostic criteria for SIRS, the more severe the patients were; the more remarkable the coagulation disturbance was, the higher the mortality was. Early intervention should be taken in such cases in order to prevent the progression of SIRS, control the occurrence of DIC, and decrease the mortality rate of critical acute stroke.

关 键 词：脑卒中 全身炎症反应综合征 凝血酶原时间 凝血酶时间 部分活化凝血活酶时间 D-二聚体 血小板 

分 类 号：R743.32[医药卫生—神经病学与精神病学] R554.8[医药卫生—临床医学]