重症患者SIRS状态下D-二聚体规律性变化的初步观察

目的通过动态观察ICU患者SIRS状态下不同时点D-二聚体水平,探讨非血栓病患者和血栓病患者D-二聚体变化的差异,以指导临床进行正确诊疗和评估预后。方法 162例入选者连续5d每6h一次复查血常规、CRP、D二聚体水平和凝血四项。根据D-二聚体水平演变,以Microsoft Exel 2003分别描绘血栓病、非血栓病患者及复合病变者的规律曲线图;描绘非血栓病SEPSIS患者和非SEPSIS患者规律曲线图。并对比以上曲线在D-二聚体水平峰谷变化及持续时间等方面差异。结果四组患者72h内高峰时间均出现在30h内,除全部为非栓塞病复合病变组外,低谷时间均在60～66h左右;非栓塞病组均较栓塞为主组曲线波动大,下降支72h后具有明显反弹和多峰多谷现象;复合病变组峰值和平均值均较单病种组高,下降支更长,其中栓塞病为主组峰值最高,全部为非栓塞病组平均值最高。结论非栓塞组患者D-二聚体水平在峰值、谷值、平均值、波动幅度和下降到正常的时间等方面均有别于血栓病组,描绘D-二聚体水平规律变化图有助于鉴别两种不同的原发病状态。感染和炎症是D-二聚体升高的主要影响因素之一,存在SEPSIS的患者D-二聚体更高。

Objective By observing d-dimer levels of SIRS patients on ICU in different time, to differentiate patients with thrombosis or not, to guide clinical diagnosis and prognosis assesement correctly. Methods Blood routine, CRP, d-dimer levels and blood clotting of all 162 cases were detected every 6 hours within successive 5 days. By using Microsoft Exel 2003 to described the curve of d-dimer among patients thrombosis, non- thrombosis and complex lesions. To make curve of patients between sepsis and non-sepsis.To compare the difference of d-dime~： in levels of peak - valley and duration. Results Within 72 hours, all patients reached to peak before 30 hours and fell to valley in 60-66 hours in addition to combined lesion group with total non-embolic disease. The curve of non-embolic group had greater fluctuation than embolic disease-based groups and had a rebounded descencting branch with multiple peaks and valleys after 72 hours. Complex lesion group had a peak and average higher than single disease group and a longer descending branch. In which, the highest peak value was appeared in embolic disease-based groups and greatest average come out in total non-embolic disease group. Conclusion D-dimer levels of non-embolic group were different from embolic disease-based groups in the peak, valley, average, fluctuation extent and the time come back to normal. It was helpful to identify those two different primary disease by describing d-dimer curve. The Infection and the inflammation were major affecting factors leading to elevated d-dimer and sepsis patients had higher d-dimer.