多器官功能不全综合征患者连续性血滤过程中凝血功能的变化分析  

Changes of Blood Coagulation Function in Patients with MODS During a Continuous Veno-Venous Hemofiltration

作　　者：罗辉遇[1] 谢长江[2] 古英明[3] 陈飞鹏[4] 

机构地区：[1]广州医学院第二附属医院老年病学科,广东省广州市510260 [2]广州医学院第二附属医院ICU科,广东省广州市510260 [3]广州医学院第二附属医院血液净化中心,广东省广州市510260 [4]广州医学院第二附属医院呼吸内科,广东省广州市510260

出　　处：《中国全科医学》2010年第15期1635-1636,1641,共3页Chinese General Practice

基　　金：广州市医药卫生科技项目(2007-YB-162)

摘　　要：目的研究多器官功能不全综合征(MODS)患者连续性静脉-静脉血滤(CVVH)过程中凝血功能的变化及临床意义。方法回顾性分析2003年6月—2008年6月我院ICU科收治的27例MODS患者CVVH过程中凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(FIB)的变化。结果 MODS患者PT、APTT明显长于正常对照组(P<0.05),FIB与对照组差异无统计学意义(P>0.05);治疗前及治疗后12、48h患者总体PT、APTT、FIB水平差异均无统计学意义(P>0.05);前稀释组患者治疗前PT和治疗后12hAPTT较后稀释组明显延长,差异有统计学意义(P<0.05);其余指标在对应时段差异均无统计学意义(P>0.05)。死亡组APTT在治疗后48h较生存组明显延长(P<0.05)。结论出血倾向和易栓状态通常存在于MODS患者中;CVVH不加重患者凝血功能的紊乱;治疗后48h的APTT水平可作为判断MODS患者预后的指标。Objective To investigate the changes of blood coagulation function and their clinical significance in the patients with multiple organ dysfunction syndrome （MODS） during a continuous veno-venous hemofiltration （CVVH）.Methods A retrospective analysis was made based on 27 patients with MODS in the department of intensive care unit in our hospital from June 2003 to June 2008.The changes of plasma prothrombin time （PT）,activated partial thromboplastin time （APTT） and fibrinogen （FIB） before and during CVVH were assessed.Results The preoperative patients had longer plasma PT and APTT （P0.05）,but no significantly different FIB（P0.05）as compared with the healthy.The total levels of PT,APTT and FIB before treatment,12 hours and 48 hours after CVVH in the patients showed no significantly different （P0.05）.The PT before treatment and APTT 12 hours after CVVH were significantly prolonged in patients of the pre-dilution group than in those of the post-dilution group（P0.05）.And no significant difference was found in the rest indicators at the same time period （P0.05）.The patients of death group had longer APTT at the 48 hour after treatment as compared with the survival （P0.05）.Conclusion Bleeding tendency and thrombosis state are common among the patients with MODS,and CVVH does not aggravate disturbance of blood coagulation function.The APTT level at the 48h after CVVH may be a predictor for prognosis of MODS.

关 键 词：多器官功能不全综合征 凝血功能 连续性静脉-静脉血液滤过 

分 类 号：R605.97[医药卫生—急诊医学]