急诊感染患者凝血障碍与脓毒症严重程度的关系研究  

Relation between coagulation disorders and sepsis severity of infected patients

作　　者：胡健[1] 尚为民[1] 段艳青[1] 程冲[1] 刘伯义[2] 

机构地区：[1]丹江口市第一医院急诊与重症科,湖北丹江口442700 [2]十堰市太和医院重症医学科,湖北十堰442000

出　　处：《中华医院感染学杂志》2013年第17期4102-4103,4114,共3页Chinese Journal of Nosocomiology

基　　金：十堰市科技攻关项目(2009045D)

摘　　要：目的探讨急性感染患者的凝血障碍与脓毒症严重程度的相关性,为临床准确判断病情,及时采取防治措施提供理论依据。方法选择80例急性感染患者,根据其全身炎症反应综合征(SIRS)及序贯器官衰竭(SOFA)评分分为单纯感染组(29例)、脓毒症组(31例)、重度脓毒症组(20例);所有患者入院24h内进行常规凝血功能检测。结果重度脓毒症组的病死率为40.0%,明显高于单纯感染组、脓毒症组的6.9%、12.9%(P<0.05);与单纯感染组、脓毒症组比较,重度脓毒症组的SOFA得分明显增高至(8.79±3.14)分(P<0.05);D-二聚体明显增高至(5201±1123)μg/L(P<0.05);血小板计数明显减少至(133.0±70.33)×109/L(P<0.05);凝血酶原时间、国际标准化率均有增长趋势但不明显;活化部分凝血活酶时间、凝血酶时间、纤维蛋白原无明显变化。结论急性感染患者的凝血障碍与脓毒症的严重程度具有密切的相关性,检测凝血功能对判断患者脓毒症的病情严重程度具有重要的参考价值。OBJECTIVE To study the relation between coagulation disorders and sepsis severity of infected patientsand provide theoretical basis for clinical precise condition and taking timely prevention and control measures.METHODS In this retrospective study, 80 patients were included. They were divided into three groups according asSIRS and SOFA scores. Infection group had 29 cases,sepsis group had 31 cases,severe sepsis group had 20 ca-ses. All cases were given routine coagulation test within 24 hours after sdmission to emergency department. RESULTS The case fatality rate of severe sepsis group was 40. 0 %,which was significantly higher than the sepsisgroup（6. 9%） and the infection group（12. 9%）. As compared with the to sepsis group and infection group, D-di-mer significantly elevated to （5201± 1123）μg/L in severe sepsis group （P〈0. 05）,SOFA scores significantly ele-vated to （8. 79±3. 14） （P〈0. 05）,PT and INR showed an upward trend, APTT,TT and FIB showed no signifi-cant changes. CONCLUSION The extent of coagulation disorders and sepsis severity of infected patients is closelycorrelated to each other. Routine coagulation and thromboelastography test has important reference value in thejudgment of the severity of illness of infected patients.

关 键 词：凝血障碍 脓毒症 急性感染 相关性 

分 类 号：R181.32[医药卫生—流行病学]