全身炎症反应综合征病人凝血功能的变化及其意义

CLINICAL SIGNIFICANCE OF COAGULATION FUNCTION CHANGES IN PATIENTS WITH SYSTEMIC INFLAMMATORY RESPONSE SYNDROME

目的通过观察全身炎症反应综合征(SIRS)危重病病人凝血功能紊乱情况,探讨凝血功能紊乱在SIRS病人中的作用及其与SIRS病情严重程度、预后的关系。方法随机选择100例合并SIRS的危重病病人,在病人入ICU次日进行血小板计数、抗凝血酶Ⅲ活性检测,采用免疫比浊法进行血浆D-二聚体定量检测;观察SIRS符合项数与凝血功能紊乱间的关系,以及存活组与死亡组凝血指标的变化。结果随着SIRS符合项数的增加,血小板计数下降,抗凝血酶Ⅲ活性减低,血浆D-二聚体含量明显升高,差异有极显著性(t=6.79～16.37,P<0.01)。存活组病人血小板计数明显高于死亡组(t=4.58,P<0.01),抗凝血酶Ⅲ活性明显高于死亡组(t=6.21,P<0.01),血浆D-二聚体含量明显低于死亡组(t=8.75,P<0.01)。结论 SIRS病人合并有凝血功能的激活,形成复杂的全身性炎症-凝血反应,炎症反应越重,凝血功能激活越明显,预后越差。

Objective To investigate the changes of coagulation function,and their relationship with the severity and prognosis of patients with systemic inflammatory response syndrome（SIRS）. Methods One hundred patients complicated by SIRS were randomly selected.One day after the patients were enrolled in ICU,platelet count and antithrombin Ⅲ were measured.Plasma D-dimer was determined by immune turbidimetry.The relationship between SIRS score and coagulation disorders,and the difference of coagulation factors between the survival and death groups were analyzed. Results As SIRS score increased,the platelet count and antithrombin Ⅲ activity of SIRS patients decreased,and the level of D-dimer significantly increased（t=6.79-16.37,P0.01）.The platelet count in the survival group was significantly higher than that of the death group（t=4.58,P0.01）.The antithrombin Ⅲ activity in the survival group was significantly higher than that of the death group（t=6.21,P0.01）.Plasma D-dimer in the survival group was significantly lower than that of the death group（t=8.75,P0.01）. Conclusion Patients with SIRS has an activation of coagulation function,which induces complex systemic inflammation-coagulation reaction.The severer the inflammation is,the more obvious the abnormal coagulation activation,and the poorer the prognosis will be.