脓毒症诱导凝血功能障碍对脓毒症患者预后的评估价值  

A clinical research on relationship between sepsis-induced coagulopathy and prognosis in patients with sepsis

作　　者：朱为民 黄丹红[1] 王巧红 卞兵兵 李萍[1] 杨鹏[1] 单仁飞[1] 张超[2] 徐颖鹤[2] 何遐遐 蒋永泼 Zhu Weimin;Huang Danhong;Wang Qiaohong;Bian Bingbing;Li Ping;Yang Peng;Shan Renfei;Xu Yinghe;He Xiaxia;Jiang Yongpo(Emergency Medicine Department,Taizhou Hospital of Zhejiang Province,Taizhou,Zhejiang 318050,China;Department of Critical Care Medicine,Taizhou Hospital of Zhejiang Province,Taizhou,Zhejiang 318050,China;Taizhou Central Hospital(Taizhou University Hospital),Taizhou,Zhejiang 318050,China)

机构地区：[1]浙江省台州医院急诊科,台州318050 [2]浙江省台州医院重症医学科,台州318050 [3]台州市中心医院(台州学院附属医院),台州318050

出　　处：《中华急诊医学杂志》2023年第6期781-786,共6页Chinese Journal of Emergency Medicine

基　　金：浙江省医药卫生研究基金(2022KY435);台州市科技计划项目(21ywb05)。

摘　　要：目的评价脓毒症诱导凝血功能障碍(SIC)预测脓毒症患者预后的价值。方法回顾性分析2019年1月至2021年12月收住本院重症医学科的脓毒症患者,根据SIC诊断标准,将患者分为SIC组、非SIC组。比较两组患者临床基线资料、危重评分、总住院时间、住ICU时间及28 d生存等情况。采用K-M法分析两组脓毒症患者28 d生存情况;采用Cox比例风险回归分析影响脓毒症患者预后的危险因素。结果共274例脓毒症患者纳入分析,其中SIC组139例,非SIC组135例。两组在血小板计数(PLT)、凝血酶原时间(PT)、降钙素原(PCT)、D二聚体、红细胞压积、红细胞分布宽度、血红蛋白、急性肾损伤(AKI)、使用连续性肾脏替代治疗(CRRT)、使用血管活性药物、序贯器官衰竭(SOFA)评分、急性生理学与慢性健康状况(APACHEⅡ)评分等比较,差异均有统计学意义(P<0.05);K-M法分析SIC组患者的28 d病死率(32.4%)高于非SIC组(14.1%),差异有统计学意义(P<0.05);Cox比例风险回归模型显示SIC评分(HR:2.17,95%CI:1.15~3.91,P<0.05)、APACHEⅡ评分(HR:1.13,95%CI:1.09~1.17,P<0.05)及是否使用血管活性药物(HR=3.66,95%CI:1.53~8.75,P<0.05)是脓毒症患者28 d死亡的独立影响因子。结论脓毒症诱导凝血功能障碍的脓毒症患者病情更加危重,死亡风险也增加;SIC评分可以较好的预测脓毒症患者的预后。Objective To evaluate the prognostic value of sepsis-induced coagulopathy(SIC)in patients with sepsis.Methods From January 2019 to December 2021,patients with sepsis admitted to the Intensive Care Unit of our hospital were retrospectively classifi ed into the SIC group and non-SIC group according to SIC diagnostic criteria.The baseline clinical data,severity score,total length of hospital stay,length of ICU stay and 28-day survival were compared between the two groups.Kaplan-Meier was used to compare the 28-day survival of patients with sepsis between the two groups. Cox proportional hazard regression model was employed to analyze the risk factors of prognosis in patients with sepsis. Results Totally 274 patients with sepsis were included in the analysis, including 139 patients in the SIC group and 135 patients in the non-SIC group. The two groups were compared in the perspectives of the Platelet count (PLT), prothrombin time (PT) , procalcitonin (PCT), D dimer, hematocrit, red blood cell distribution width, hemoglobin, acute kidney injury (AKI), the use of continuous renal replacement treatment (CRRT), the use of vasoactive drugs, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACHE Ⅱ ) score were compared between the two groups and the difference were statistically different (all P<0.05). Kaplan-Meier analysis showed that the 28-day mortality rate in the SIC group was signifi cantly higher than that in the non-SIC group (32.4% vs. 14.1%, P<0.05). COX proportional hazard model showed that SIC score (HR= 2.17, 95% CI: 1.15-3.91, P<0.05), APACHE Ⅱ score (HR= 1.13, 95% CI: 1.09-1.17, P<0.05) and the use of vasoactive drugs (HR=3.66, 95% CI: 1.53-8.75, P<0.05) were independent infl uencing factors for 28-day death in patients with sepsis. Conclusions Patients with sepsis and SIC have more severe disease and increased mortality risk. SIC score exhibits good clinical value in predicting the prognosis of patients with sepsis.

关 键 词：脓毒症 脓毒症诱导凝血功能障碍 血小板计数 国际标准化比值 序贯器官衰竭 急性生理与慢性健康状况评分Ⅱ 预后 评估 

分 类 号：R459.7[医药卫生—急诊医学]