老年危重症患者凝血功能与预后的关系研究

Coagulation Function and Prognosis in Elder Patients with Critical Illness

目的探讨老年危重症患者凝血功能与急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分及预后的关系。方法选取老年危重症患者95例,测定凝血功能、D二聚体、血小板计数和APACHEⅡ评分,分析APACHEⅡ评分与凝血功能、D二聚体、血小板计数的关系。并将患者根据预后分为存活组和死亡组,比较两组的凝血功能、D二聚体和血小板计数。结果死亡组血小板水平显著低于存活组,APACHEⅡ评分、凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)和D二聚体阳性率均高于存活组,差异有统计学意义(P<0.05)。随着APACHEⅡ评分的升高,PT、INR、APTT、TT、D二聚体阳性率及死亡率显著升高,差异有统计学意义(P<0.05);血小板计数显著降低,差异亦有统计学意义(P<0.05)。结论老年危重症患者病情越重,凝血功能越差,血小板水平越低,死亡率越高。

Objective To explore the relationship between coagulation function and acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score and prognosis in elder critically ill patients. Methods Ninety -five eider patients with critical illness were enrolled. The patients were divided according to the prognosis as survival group and dead group. The levels of coagulation function, D dimer and platelet count and the APACHE Ⅱ scores were evaluated and compared between the two groups. Results The platelet level was significantly lower in the dead group than in the group, however the APACHE Ⅱ score, prothrombin time （PT）, international normalized ratio （INR）, activated partial thromboplastin time （APTT）, thrombin time （TT） and positive ratio of D dimer were significantly higher （ P 〈 0. 05 ）. The levels of PT, INR, APTT, TT and the positive ratio of D dimer, mortality rate were significantly increased following the elevation of APACHE Ⅱ score （P 〈 0. 05 ）, and the platelet levels decreased （P 〈 0. 05） . Conclusion For elder patients with critical illness, the severer the condition, the poorer the coagulation function, the lower the platelet count, and the higher the mortality rate.