ICU菌血症老年患者血小板与凝血功能检测的临床意义研究

Clinical significance of detection of platelet and coagulation function of elderly patients with bacteremia in ICU

目的观察和分析重症监护病房(ICU)菌血症老年患者血小板(PLT)及凝血功能检测的意义,为制定该类医院感染的预防控制策略提供客观依据。方法选取2013年1月-2014年12月的80例ICU菌血症老年患者作为研究对象,根据其预后将其分为存活组52例和死亡组28例,对患者入院时、血培养首次呈阳性时的外周血PLT及部分活化的凝血酶原时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)和纤维蛋白原(FIB)等凝血功能指标进行检测和比较;应用SPSS 13.0软件进行统计分析。结果与入院时比较,患者在血培养首次呈阳性时的PLT显著下降,而APTT、PT和FIB水平显著升高,差异均有统计学意义(t=8.346、7.112、6.034、5.367,P<0.05);不同病原菌感染患者PLT及凝血功能指标的差异均无统计学意义;死亡组患者的PLT计数显著低于存活组而APTT显著高于存活组,差异均有统计学意义(t=11.015、8.673,P<0.05),多因素logistic回归分析结果显示,患者死亡与年龄、PLT和APTT水平具有相关性,差异均有统计学意义(P<0.05)。结论 ICU菌血症老年患者表现为PLT的损耗和凝血功能的下降,PLT计数及APTT水平与患者的预后相关,检测PLT计数和凝血功能指标可用于辅助该类患者的早期诊断和预后预测。

OBJECTIVE To observe and analyze the significance of detection of platelet（PLT）and blood coagulation function of the elderly patients with bacteremia in the intensive care unit（ICU）so as to provide objective basis for prevention and control of nosocomial infections.METHODS A total of 80 elderly patients with bacteremia who were treated in the ICU from Jan 2013 to Dec 2014 were recruited as the study objects and divided into the survival group with 52 cases and the death group with 28 cases according to the clinical outcomes.The peripheral blood PLT and the blood coagulation function indicators such as partly activated prothrombin time（APTT）,prothrombin time（PT）,thrombin time（TT）,and fibrinogen（FIB）were detected and compared at the admission to the hospital or at the time when the blood specimens were cultured positive for the first time.The statistical analysis was performed with the use of SPSS13.0software.RESULTS The PLT were significantly decreased,while the levels of APTT,PT,and FIB of the patients were remarkably elevated at the time when the blood specimens were cultured positive for the first time,as compared with those at the admission to the hospital,there was significant difference（t=8.346,7.112,6.034,5.367,P〈0.05）.There was no significant difference in the PLT counts or the blood coagulation indicators among the patients infected with different species of pathogens.The PLT counts of the death group were significantly lower than those of the survival group,while the APTT of the death group was significantly higher than that of the survival group（t=11.015,8.673,P〈0.05）.The multivariate logistic regression analysis indicated that the death of the patients was significently associated with the age,PLT and APTT level（P〈0.05）.CONCLUSIONThe ICU elderly patients with bacteremia are characterized by the loss of PLT and the decline of blood coagulation function;the prognosis of the patients is associated with the PLT counts and APTT level.The detection of the PLT counts and blood coagulation function indicators can be used as an auxiliary mean for the early diagnosis and prediction of prognosis of the patients.