脓毒症凝血功能异常的发生率和临床意义

Prevalence and clinical significance of coagulation abnormalities in sepsis

目的:探讨脓毒症患者中凝血异常的发生率和病情严重程度的关系。方法:分析了2009年3月-2009年8月在上海交通大学附属第一人民医院ICU和急诊病房住院符合脓毒症诊断标准的124例。分别在入院第1、7、14天测D-二聚体(D-dimer)、血小板计数、凝血全套。入院当天给以APACHEII评分、SOFA评分。根据D-dimer值分为3组,分别是D-dimmer<256μg/L、256≤D-dimer<1000μg/L、D-dimer≥1000μg/L。结果:所有入选病例第1、7、14天发生凝血异常的比例分别是38.7%、41.1%、45.9%。凝血异常组和无凝血异常组比较,D-dimer差异有统计学意义。随着D-dimer浓度增加,APACHEII和SOFA分值增加。结论:近半数脓毒症患者存在凝血功能障碍,其中D-dimer检测早期凝血功能障碍更为敏感。D-dimer与脓毒症的严重程度相关。

Objective：To investigate the relationship between prevalence of coagulation abnormalities and severity in sepsis.Method：124 sepsis patients in our ICU and emergency ward from Mar 2009 to Aug 2009 were divided into three groups according to various concentration of D-dimer.They were D-dimmer256 μg/L group,256≤D-dimer1000 μg/L group,D-dimer≥1 000 μg/L group.D-dimer,PLT and complete coagulation test on day1,day7 and day14 were measured.All the patients received APACHE II and SOFA tests at the 1st day.Result：The ratio of coagulation abnormalities at day1,day7 and day14 were 38.7%,41.1%,45.9%,respectively.D-dimmer increased significantly in coagulation abnormalities groups compared with that in non-coagulation abnormalities groups.With the increase of D-dimmer,the scores of SOFA and APACHE II were up-regulated.Conclusion：Nearly half of the sepsis patients had coagulation abnormalities.D-dimer was more sensitive to test early coagulation abnormalities and had a rational relationship with severity of sepsis.