重度脓毒症凝血功能紊乱与病情严重度及预后的关系

Relationship between coagulation disorders and severity and prognosis in severe sepsis

目的探讨重度脓毒症凝血功能紊乱与病情严重度及预后的关系。方法将2002年11月至2005年3月收住全国20家三级医院脓毒症并发急性器官功能不全患者694例分为死亡组和生存组,分析比较两组患者主要凝血指标的差异及主要凝血指标异常与病情严重度(APACHEⅡ评分)的关系。结果(1)死亡组患者与凝血功能相关的主要指标:血小板明显低于存活组(P<0.05),Ddimer明显高于生存组(P<0.05),凝血酶元时间(PT)、部份凝血活酶时间(APTT)、TT均较生存组延长(P<0.05)。(2)血小板下降、血小板下降与Ddimer同时升高,APTT和FDP异常患者的APACHEⅡ评分明显高于生存组(P<0.05)。结论与凝血功能相关的主要指标:血小板、Ddimer、PT、APTT、TT的检测对判断重度脓毒症的预后及评估病情严重度有一定指导意义。

Objective To explore the relationship between coagulation disorders and severity and prognosis in severe sepsis. Methods Six hundred and ninety-four sepsis patiens with acute organ failures from 20 university hospitals were collected. Patients were divided into two groups according to survival （ n = 239） or death （ n = 277）. Platelets and five coagulation markers were measured at the admission day. The diagnosis of severe sepsis was made according to the definitions for sepsis and organ failure of ACCP/SCCM. The severity of illness was determined by APACHE-Ⅱ score. The differences of coagulation markers between the two groups were analyzed, and the relationship between the coagulation markers and APACHE- Ⅱ score were studied. Results Plateletcount was decreased and D-dimer elevated obviously in the death group （P〈0.05）. Prothrombin time （PT）, activated partial thromboplastin time （APTT）, thrombin time （TY） were prolonged in the death group （ P 〈 0.05）. The APACHE-Ⅱ score of the death group was much higher than that of the survival group （ P 〈 0.05 ）. Conclusion Platelet count and prothrombin time （PT）, actirated partial thrombo plastin time （APTT）, thrombin time （TT） is associated with the prognosis and severity of severe sepsis. Restoration of the disrupted coagulantion pathways may improve the prognosis of severe sepsis.