急诊感染患者凝血障碍与脓毒症严重程度的关系  

Coagulation disorders are associated with severity of sepsis in infected patients admitted toemergency department

作　　者：张伟[1] 林兆奋[1] 瞿金龙[1] 常亮[1] 管军[1] 

机构地区：[1]上海长征医院急救科,上海200003

出　　处：《中华急诊医学杂志》2012年第2期123-127,共5页Chinese Journal of Emergency Medicine

摘　　要：目的 探讨感染患者凝血功能障碍与脓毒症严重程度的关系.方法 回顾性分析2010年1月至2011年3月入住上海长征医院急救科的75例临床确诊为感染且入院24 h内抽取贵要静脉血检查血栓弹力图和常规凝血功能的患者,男性51例,女性24例,年龄为（55.8±18.1）岁.根据入院24 h内是否伴有全身炎症反应综合征（SIRS）及序贯器官衰竭估计（SOFA）评分进行分组.不伴有SIRS为单纯感染组；伴有SIRS但SOFA评分小于5分为脓毒症组；SOFA评分大于或等于5分为重度脓毒症组.3组比较采用单因素方差分析ANOVA,用LSD法作两两组间比较.结果 重度脓毒症组（n=19）与脓毒症组（n=29）单纯感染组（n=27）相比：D-二聚体显著增高（F=3.388,P=0.040）；血小板计数显著减少（F =3.839,P=0.026）；凝血酶原时间和国际标准化率有延长趋势,但差异无统计学意义（F =2.782,P=0.069; F=2.657,P=0.077）.血栓弹力图指标中,反映血栓强度的最大幅度（MA）值显著减小（F=5.841,P=0.004）.结论 感染患者的凝血功能障碍程度与脓毒症严重程度密切相关.Objective To investigate the relation between coagulation disorders and sepsis severity of infected patients.Methods In this retrospective study,75 patients,51 males,24 femalse,with age（55.8± 18.1）,were included from January 2010 to March 2011.They were clinically diagnozed as infection,and had Thromboelastography（TEG）and routine coagulation test within 24 hours after admission to emergency department.They were divided into 3 groups based on SIRS and SOFA score within 24 hours after admission：a）infection group,patients without SIRS; b）sepsis group,patients with SIRS and SOFA score less than 5; c）severe sepsis group,patients with SOFA score greater than or equal to 5.LSD was used to compare between two groups if one-way ANOVA of three groups comparasion showed significant differences.Results In comparasion to sepsis group（n =29）and infection group（n =27）,D-dimer elevated significantly in severe sepsis group（n =19）（F =3.388,P =0.004）,and platelet count decreased significantly（F =3.839,P =0.026）,INR and KPTT showed an increase trend without significant difference （F =2.657,P =0.077 ; F =2.782,P =0.069）; TEG showed MA obviously decreased（F =5.841,P =0.004）,while there were nostatistically significant differences among other data.Conclusions The extent of coagulation disorders and sepsis severity of infected patients is closely correlated to each other.

关 键 词：感染 脓毒症 重度脓毒症 血小板 D-二聚体 凝血酶原时间 国际标准化率 血栓弹力图 MA值 

分 类 号：R631[医药卫生—外科学]