危重患者抗凝血酶与纤溶功能的动态变化

The dynamic changes of antithrombase and Dbrinolytic function in the critical patients

目的观察危重患者抗凝血酶和纤维蛋白溶解功能的变化。方法重症监护病房(ICU)住院患者87例(病例组),病例组按不同的临床表现,以有无全身炎症反应综合征(SIRS)或多器官功能障碍综合征(MODS),将患者分为SIRS组(n=68)与非SIRS组(n=19)、MODS组(n=37)与非MODS组(n=50)。选择同期本院健康体检者31人,作为对照组(n=31)。分别测定病例组患者进入ICU第1、3、5天静脉血血小板计数(PLT)及血浆抗凝血酶活性(AT:A)、纤溶酶原活性(PLG:A)、纤维蛋白原(FIB)及D-二聚体(D-D)浓度。结果与对照组比较,病例组进入ICU第1天血浆AT:A、PLG:A、PLT降低,血浆F1B、D-D浓度升高(P<0.01);与非SIRS组、非MODS组比较,SIRS组、MODS组各时间点血浆AT:A、PLG:A、PLT降低,血浆D-D浓度升高(P<0.01);与进入ICU第1天比较,第3、5天SIRS组、MODS组血浆D-D浓度升高,第5天血浆PLT,FIB浓度下降(P<0.05或0.01);第5天MODS 组血浆PLG:A降低(P<0.05);第5天非MODS组血浆AT:A、PLG:A升高(P<0.05)。结论血浆AT :A、PLG:A、PLT、FIB及D-D水平可在一定程度上反映SIRS和MODS病情的严重程度,还可作为SIRS 和MODS的辅助诊断指标,有助于早期预防弥漫性血管内凝血的发生。

Objective To evaluate the dynamic change of the antithrombase and fibrinolytic function in the critical patients.Methods Eighty-seven patients hospitalized in ICU were studied. According to the clinical manifestation, all patients were divided into systemic inflammatory response syndrome (SIRS) group ( n = 68) and non-SIRS group ( n = 19), or multiple organ dysfunction syndrome (MODS) group ( n = 37) and non-MODS group (n = 50) respectively. Thirty-one healthy volunteers were selected for control in the same period. The intravenous blood samples were taken 1,3 and 5 days after ICU admission to measure platelet,count (PLT) , and the plasma levels of antithrombase activity (AT: A), plasminogen activity (PLG: A), fibrinogen (FIB) and D-dimer (D-D) concentrations.Results AT: A, PLG: A and PLT were lower and FIB and D-D levels higher in all patients than control levels (P < 0.05or 0.01) . AT: A, PLG:A and PLT in SIRS and MODS group were significantly lower, but D-D level was higher than those in non- SIRS and non-MODS groups respectively ( P < 0.01). Compared with the values on the first day, in SIRS and MODS groups D-D level increased significantly on third and fifth day, PLT and FIB level reduced on fifth day (P < 0.05 or 0.01), in MODS group PLG: A decreased on fifth day ( P < 0. 05), while in non- MODS group AT: A and PLG: A increased on fifth day ( P < 0.05 ) . Conclusion AT: A, PLG : A,PLT,FIB and D-D levels can indicate the severity of the SIRS and MODS to some extent, may serve as the auxiliary diagnostic criteria of SIRS and MODS and be helpful for early prophylaxis against disseminated intravascular coagulation.