动脉瘤性蛛网膜下腔出血术后肺炎患者凝血功能变化及对预后的影响  

Change of coagulation function of aneurysmal subarachnoid hemorrhage patients with postoperative pneumonia and influence on prognosis

作　　者：王清青 彭瀚 孙宝飞 林丹 杨明 WANG Qing-qing;PENG Han;SUN Bao-fei;LIN Dan;YANG Ming(The Affiliated Hospital of Guizhou Medical University,Guiyang,Guizhou 550004,China;不详)

机构地区：[1]贵州医科大学附属医院医院感染管理科,贵州贵阳550004 [2]贵州医科大学附属医院神经外科,贵州贵阳550004 [3]贵州医科大学基础医学院人体解剖学教研室,贵州贵阳550004

出　　处：《中华医院感染学杂志》2023年第14期2111-2115,共5页Chinese Journal of Nosocomiology

基　　金：贵州省科学技术厅基金资助项目(黔科合基础-ZK[2023]一般316)贵州医科大学附属医院博士后启动基金资助项目(BSH-Q-2020-03)。

摘　　要：目的探讨动脉瘤性蛛网膜下腔出血术后肺炎患者凝血功能变化及对预后的影响。方法选取2019年1月-2020年12月在贵州医科大学附属医院神经外科重症监护病房就诊的动脉瘤性蛛网膜下腔出血术后肺炎患者,随访截至2021年7月31日,以全因死亡为随访终点。根据随访预后分为存活组75例和死亡组16例,采用Cox比例风险回归模型分析凝血功能相关指标对患者预后的影响。结果死亡组国际标准化比值(INR)、凝血酶原时间(PT)和D-二聚体(D-D)值均高于存活组,凝血酶原时间活动度(PTA)值低于存活组(P<0.05)。活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)和凝血酶时间(TT)在两组间比较,无统计学差异。用性别、年龄、基础疾病及实验室检查结果对模型进行调整,多因素分析结果显示:D-D>3.8μg/ml、PT>13.7 s和INR>1.2是aSAH术后肺炎患者死亡的危险因素(P<0.05)。结论D-D、PT和INR增高的动脉瘤性蛛网膜下腔出血术后肺炎患者发生死亡的危险性更大。OBJECTIVE To explore the change of coagulation function of the aneurysmal subarachnoid hemorrhage patients with postoperative pneumonia and observe the influence on prognosis.METHODS The aneurysmal subarachnoid hemorrhage patients with postoperative pneumonia who were treated in intensive care unit of neurosurgery department of the Affiliated Hospital of Guizhou Medical University from Jan 2019to Dec 2020were recruited as the study objects.The follow-up terminated for all-cause mortality on July 31,2021.The patients were divided into the survival group with 75cases and the death group with 16cases according to the follow-up prognosis.The effect of the coagulation function indexes on the prognosis was observed by means of Cox proportional risk regression model.RESULTS The international normalized ratio(INR),prothrombin time(PT)and D-dimer(D-D)value of the death group were significantly higher than those of the survival group;the prothrombin time activity(PTA)of the death group was significantly lower than that of the survival group(P<0.05).There were no significant differences in the activated partial-thromboplastin time(aPTT),fibrinogen(FIB)and thrombin time(TT)between the two groups.The model was adjusted by using gender,age,underlying diseases and result of laboratory test,and the result of multivariate analysis showed that the D-D more than 3.8μg/ml,PT more than 13.7s and INR more than 1.2were the risk factors for death of the aneurysmal subarachnoid hemorrhage patients with postoperative pneumonia(P<0.05).CONCLUSIONThe aneurysmal subarachnoid hemorrhage patients with postoperative pneumonia who have the rise of D-D,PT and INR are at higher risk of death.

关 键 词：动脉瘤性蛛网膜下腔出血 术后肺炎 凝血功能 危险因素 预后 随访 

分 类 号：R743.35[医药卫生—神经病学与精神病学]