脓毒性休克合并MODS患者凝血功能障碍及预后  

Outcome and coagulation disroders in septic shock with mutiple organ dysfunction syndreme

作　　者：俞凤[1] 秦克秀[1] 张泓[1] 徐俊[1] 

机构地区：[1]安徽医科大学第一附属医院急诊科,安徽合肥230022

出　　处：《安徽医药》2009年第9期1074-1076,共3页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨脓毒性休克合并MODS患者凝血功能障碍及预后。方法选取2005年1月至2008年8月入住我院急诊科及ICU的脓毒症患者,对其中56例脓毒性休克者病历资料进行回顾性分析。结果脓毒性休克合并MODS患者死亡率是64.3%,合并DIC占57.2%,脓毒性休克存活与非存活病人相比,器官损害个数和DIC的发生非存活组与存活组相比有统计学意义(P<0.05);存活组休克与DIC发生的时间较非存活组早,两组相比有统计学意义(P<0.01)。DIC组器官损害个数较非DIC组多,两组相比有统计学意义(P<0.05),且DIC组预后显著较差(P<0.01);早发DIC与迟发DIC临床特征比较,虽入院SOFA评分在早发DIC较迟发DIC更严重(P<0.05),但迟发DIC较早发DIC预后差(P<0.05),早发DIC组较迟发DIC组更易合并急性肾功能损害(P<0.05)。入院时凝血参数比较仅血小板计数两组相比差异有显著性,凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原降解产物(FDP)及D-二聚体(D-d)无差异。结论脓毒性休克合并MODS及播散性血管内凝血是死亡的主要原因;早期发生的脓毒性休克及早发DIC较迟发者预后较好,早发DIC者更易合并肾功能不全;入院时血小板计数的下降是预示DIC发生的敏感指标。Aim To study outcome and coagulation disroders in septic shock with mutiple organ dysfunction syndreme （MODS）. Methods A retrospective study of 56 patients in septic shock with mutiple organ dysfunction syndreme was made in a emergency department and a general ICU between January 2005 and August 2005. Results The mortality rate was 64.3% in septic shock with MODS. 57.2% of patients presented disseminated intravascular coagulation （DIC）. Nonsurvions patients had higher the number of organ dysfunction and DIC than survion patients（ P 〈0.05）. Survion patients had earlier onset time of Septic shock and DIC than nonsurvion patients（ P 〈 0. 01 ）. The patients with DIC had higher the number of organ dysfunction and mortality rate than the patients without DIC （ P 〈 0.05 ）. Patients of early DIC had higher sequential organ failure assessment（SOFA） scores on admission than patients of late DIC. Howerver,the mortality rate was lower in patients with early DIC than patients with late DIC. The patients of early DIC had more severe renal dysfunc- tion than the patients of late DIC. Patients with D1C had lower BPC count than patients without DIC on admission. PT, APTT, FDP and D- d didnt have significantly different between two groups on admission. Conclusion Motality is associated with MODS and DIC in septic shock. The mortality rate was lower in patients with early DIC and early shock than patients with late DIC and late shock. Early DIC had more severe renal dysfunction than the patients of late DIC. Admission BPC count was a good prodictor of DIC in septic shock.

关 键 词：脓毒症 脓毒性休克 多器官功能障碍综合征 播散性血管内凝血 预后 

分 类 号：R459.7[医药卫生—急诊医学]