凝血机制异常对多脏器功能障碍综合征预后影响的研究  

Study on Coagulation Dysfunctions in Patients with Multiple Organ Dysfunction Syndrome

作　　者：张会云[1] 张磊[1] 王勇强[1] 曹书华[1] 

机构地区：[1]天津市第一中心医院危重病研究所,300192

出　　处：《天津医药》2008年第8期591-593,共3页Tianjin Medical Journal

摘　　要：目的:探讨多脏器功能障碍综合征(MODS)患者凝血功能紊乱与病情严重程度及预后的关系。方法:根据预后情况,将重症监护病房的MODS患者分为生存组23例,死亡组37例,分别检测血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、蛋白C(PC)活性,分析比较2组患者上述指标的差异及主要凝血指标与病情严重度(APACHEⅡ评分)的相关性。结果:MODS死亡组与生存组比较PLT减少(P<0.05)、PT延长(P<0.05)、APTT延长(P<0.01)、Fib升高(P<0.05)、PC活性降低(P<0.01);PLT(r=-0.42)、PC活性(r=-0.31)、APTT(r=0.37)、PT(r=0.32)与APACHEⅡ评分有相关性(P<0.05或P<0.01)。结论:MODS患者存在凝血功能紊乱,PC活性动态监测及凝血指标对判断患者的预后及评估病情严重程度有重要意义。Objective： To explore the relationship between coagulation disorders and severity and prognosis in Multiple Organ Dysfunction Syndrome （MODS）.Methods.All the patients were divided into 2 groups which included survival （n=23） and death （n=37） groups,levels of platelet count （PLT）, prothrombin time （PT）, activated partial thromboplastin time（APTT） and fibrinogen （Fib）, protein C activity were measured in all patients at the admission day.The differences of coagulation markers between the two groups were analyzed and the relationship between the coagulation markers and APACHE Ⅱ score were studied.Results：Platelet count was decreased （P 〈 0.05 ）,so was PT （P 〈 0.05）and APTT （P 〈 0.01 ）prolonged obviously in death groups.Fib was inceased （P 〈 0.05 ）and protein C activity（P 〈 0.01 ）was decreased in the death group, and these changes were closely correlated with the APACHE II score.Conclusions. There are the dysfunctions of coagulation in the patients with MODS, protein C activity and PT,APTT,PLT is associated with the prognosis and severity of MODS.

关 键 词：多器官功能衰竭 血小板计数 部分促凝血酶原时间 预后 

分 类 号：R59[医药卫生—内科学] R619.1[医药卫生—临床医学]