凝血功能监测在老年AECOPD患者病情和预后评估中的临床意义

Abnormality of coagulation functions in assessing the severity and prognosis of the senile patients with acute exacerbation of chronic obstructive pulmonary disease

目的:研究老年慢性阻塞性肺疾病急性加重(AECOPD)患者凝血功能的异常在评估病情严重度和预后的临床价值。方法:以我院呼吸、危重病科收治的102例老年AECOPD患者作为研究对象,按有无并发全身炎症反应综合征(SIRS)分为SIRS组和非SIRS组;根据预后分为生存组和死亡组。入院后即测定血浆凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-dimer)及血小板(PLT),同时记录患者的急性生理和慢性健康状况评分(APACHEⅡ)。结果:SIRS组、非SIRS组比较,SIRS组PT、APTT较后者低,而FIB较后者高,两组PLT无明显统计学差异;死亡组PT、APTT明显低于存活组,FIB高于存活组,而PLT死亡组明显低于存活组。PT、APTT、FIB、PLT与APACHEⅡ评分直线相关分析相关系数分别为:-0.395、-0.499、0.509、0.434,且PT、APTT、FIB、D-dimer、PLT异常组与正常组比较APACHEⅡ评分有显著统计学差异。结论:老年AECOPD患者凝血功能出现显著异常,其中PT、APTT、D-dimer、PLT对病情严重度及预后有重要的判断价值。

Objective： To investigate the relationship between the severity,prognosis of the senile patients with acute exacerbation of chronic obstructive pulmonary disease（ AECOPD） and the coagulation dysfunction. Method： 102 cases of AECOPD patients were divided into 2 groups： systemic inflammatory response syndrome（ SIRS） and non-SIRS according to the criteria of SIRS; survival group and death group according to the outcome. Platelets and four coagulation markers were measured and APACHEⅡ scores were determined at the admission day. The differences of coagulation markers between the two groups were analyzed and the relationship between the coagulation markers and APACHEⅡ SCORES were studied. Result： The level of prothrombin time（ PT） 、activated partial thromboplastin time（ APTT） were lower and the level of fibrinogen（ FIB） was dramatically higher in SIRS group than those of non-SIRS group,while blood platelet（ PLT） had no remarkable statistic difference. The level of FIB was higher and the level of PLT was dramatically lower in death group than those of survival group,while PT,APTT were significantly shorter. APACHEⅡ scores of patients with abnormal PT、APTT、FIB、D-dimmers、PLT and platelet were dramatically higher than those of patients with normal markers. Conclusion： The coagulation dysfunction of AECOPD patients was associated with the severity and prognosis of the illness.