创伤后脓毒症患者凝血紊乱及其与MODS评分的相关性研究

Studies on coagulation dysfunction in sepsis in traumatic patients

目的研究创伤后脓毒症患者凝血功能的变化及其与多器官损伤(MODS)评分的相关性。方法按照脓毒症诊断标准,将创伤后患者分为脓毒症和非脓毒症组,每组40例,一经确诊即抽血检查凝血四项、D-二聚体浓度、血小板计数及白细胞计数,并对脓毒症组患者进行MODS评分。结果与非脓毒症组比较,脓毒症组的APTT、PT显著延长,D-二聚体浓度、白细胞计数显著增高,纤维蛋白原浓度、血小板计数显著降低(P<0.05)。脓毒症组的MODS评分与血小板计数、D-二聚体浓度显著相关性(P<0.01),与APTT、PT、纤维蛋白原浓度、白细胞、年龄等指标无相关性。结论创伤后脓毒症患者存在凝血系统功能紊乱,其中D-二聚体浓度、血小板计数与脓毒症的严重程度显著相关。

Objective To study coaguloparhy in post traumatic patients complicated by sepsis, and to look for the relationship between coagulopathy and multiple organ dysfunction syndrome （MODS）. Method A total of 80 patients were enrolled in present study. According to the diagnostic criteria for sepsis （Dec. 2001, International Sepsis Consensus Conference）, these patients were divided into two groups, sepsis group and non-sepsis group, with 40 cases for each group. The venous blood samples were taken from the patients as soon as they entered ICU and following parameters were determined： prothrombin time （PT）, activated partial thromboplastin time （APTT）, fibrinogen （Fib）, international normalized ratio （INR）, D-dimer, platelet （PLT）, and white blood cells （WBC）. Results The findings of the present study were as follows： APTT and PT were longer in sepsis group than that in non-sepsis group. D-dimer and WBC were higher in sepsis group than that in non-sepsis group. Fib and PLT were lower in sepsis group than that in non-sepsis group. All the differences were of statistical significance. MODS scores in sepsis group were significantly related with PLT and D-dimer （P〈0. 0l）, and showed no relationship with other factors such as APTT, PT, Fib, WBC and patientg age. Conclusions The coagulation dysfunction is much severe in the traumatic patients with sepsis than that in the patients without sepsis. The severity of post traumatic sepsis is significantly related only with PLT and D-dimer, which may therefore he act as adoptahle parameters in the developing system of sepsis score.