感染性休克患者凝血机制紊乱对病情严重程度及预后的评估价值  

Evaluation value of coagulation mechanism disorder on severity and prognosis of septic shock patients

作　　者：张磊 鲍林林 陆敬宪 ZHANG Lei;BAO Lin-lin;LU Jing-xian(Critical Medicine Department,Suqian TCM Hospital,Suqian 223800,China)

机构地区：[1]宿迁市中医院重症医学科,江苏宿迁223800

出　　处：《临床医学研究与实践》2020年第7期21-23,共3页Clinical Research and Practice

摘　　要：目的探讨感染性休克患者凝血机制紊乱判断病情严重程度及预后的价值。方法选择我院收治的感染性休克患者90例,结合患者病情程度与多器官功能障碍综合征诊断标准将患者分为无功能障碍组(63例)与功能障碍组(27例)。入院后24 h内采集患者静脉血,检测D-二聚体(D-D)、纤维蛋白原(FIB)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、血小板计数(PLT);选取同期来我院接受体检的健康体检者60例作为对照组。比较三组受检者的凝血指标。结果无功能障碍组的D-D水平高于对照组,APTT、PT长于对照组,PLT低于对照组(P<0.05);功能障碍组的D-D水平高于对照组,FIB、PLT低于对照组,TT、APTT、PT长于对照组(P<0.05);功能障碍组的FIB水平低于无功能障碍组,TT长于无功能障碍组(P<0.05)。功能障碍组患者的临床病死率为62.96%,明显高于无功能障碍组的36.51%(P<0.05)。存活组患者的FIB水平高于死亡组,TT短于死亡组(P<0.05)。多因素Logistic回归分析结果显示,TT为感染性休克患者死亡的独立危险因素(P<0.05)。结论感染性休克患者的凝血机制会出现紊乱,临床通过严密监测凝血指标变化情况能准确判断患者病情严重程度,并准确评估患者预后。Objective To explore the value of the coagulation mechanism disorder in patients with septic shock in judging the severity of disease and prognosis.Methods Ninety patients with septic shock admitted in our hospital were selected and divided into non-dysfunction group(63 cases)and dysfunction group(27 cases)according to the patients'condition and the diagnostic criteria of multiple organ dysfunction syndrome.Within 24 hours after admission,venous blood of patients was collected to detect the D-Dimer(D-D),fibrinogen(FIB),thrombin time(TT),activated partial thromboplastin time(APTT),prothrombin time(PT)and platelet count(PLT).Sixty healthy people who received physical examination in our hospital in the same period were selected as control group.The coagulation indexes among the three groups were compared.Results The level of D-D in the non-dysfunction group was higher than that in the control group,APTT and PT were longer than those in the control group,PLT was lower than that in the control group(P<0.05);the D-D level of the dysfunction group was higher than that in the control group,the FIB level and PLT were lower than those in the control group,TT,APTT and PT were longer than those in the control group(P<0.05);the FIB level in the dysfunctional group was lower than that in the non-dysfunctional group,and TT was longer than that in the non-dysfunctional group(P<0.05).The clinical mortality of patients in the dysfunctional group was 62.96%,which was significantly higher than 36.51%in the non-dysfunctional group(P<0.05).The FIB level in the survival group was higher than that in the death group,and TT was shorter than that in the death group(P<0.05).Multivariate Logistic regression analysis showed that TT was an independent risk factor for death in septic shock patients(P<0.05).Conclusion The coagulation mechanism of patients with septic shock will be disordered.Clinical monitoring of the coagulation indexes can accurately determine the severity of patients'condition and accurately evaluate the prognosis of patient

关 键 词：感染性休克 凝血机制 多器官功能障碍综合征 

分 类 号：R631.4[医药卫生—外科学]