重症患者凝血指标对病情及预后的评价作用

Evaluation Effect of Coagulation Indicators on the Severity and Prognosis of the Disease in Critically Ill Patients

目的探讨重症患者凝血指标对病情严重程度及预后评价的意义。方法选择2010年11月至2012年6月住院的重症患者309例。根据患者入科24h内的急性生理及慢性健康状况评分Ⅱ(APAHEⅡ)分为轻型组(APACHEⅡ<20)及重型组(APACHEⅡ≥20),根据入科14d预后分为存活组及死亡组,检测入住ICU2h内的血小板(PLT)、血小板压积(PCT)、大血小板比率(PLCR)、血小板平均容积(MPV)、血小板分布宽度(PDW)、凝血酶原时间(PT)、凝血酶原活动度(PTA)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)、D-二聚体和血清Ca2+浓度,运用非参数检验及Logistic回归分析凝血指标对重症患者病情严重程度及预后的评估作用。结果与轻型组比较,重型组患者PLT减少,PT延长,PTA降低,FIB减少,TT延长,D-二聚体升高(P<0.05);与存活组比较,死亡组患者血清Ca2+浓度降低,PT延长,PTA降低,APTT延长,TT延长,D-二聚体升高(P<0.05);D-二聚体最终进入回归模型(P<0.05)。结论重症患者凝血指标对病情严重程度及预后判断有意义,D-二聚体可以作为重症患者死亡的危险因素。

Objective To explore the evaluation effect of coagulation parameters on the severity and prognosis of the disease in critically ill patients. Methods Information of 309 critically ill patients hospitalized in ICU was selected from November 2010 to June 2012. According to APACHEⅡ score,patients were divided into slight group( APACHEⅡ score &lt; 20) and severe group( APACHEⅡscore≥20),which were calculated within 24 hours of admission. According to prognosis 14 days after the date of admission,patients were divided into survival group and death group. The venous blood of all patients within 2 hours of admission were collected and platelet( PLT),platelet pressure product( PCT),large platelet ratio( PLCR),mean platelet volume( MPV),platelet distribution width( PDW),prothrombin time( PT),prothrombin activity degress( PTA),activated partial thromboplastin time( APTT),fibrinogen( FIB),thrombin time( TT),D- dimer( D- Dimer) and serum Ca 2 + concentration were detected. The evaluation effect of coagulation parameters of patients with severe on the severity and prognosis was analyzed by non- parametric tests and logistic regression analysis. Results Compared with the slight group,PLT,PTA,FIB significantly reduced,PT and TT significantly prolonged, D- dimer significantly increased in severe group( P &lt; 0. 05); compared with the survival group,serum Ca 2 + concentration significantly reduced,PT,APTT,TT significantly prolonged,PTA significantly reduced and D- dimer significantly increased in death group( P &lt; 0. 05); D- dimer entered into the regression model eventually( P &lt;0. 05). Conclusion Coagulation indicators of patients with critically ill had an significant evaluation effect to explore the severity and prognosis. D- dimer could be be considered as a risk factor for death in patients with critically ill.