血小板、D-二聚体在感染性休克早期集束化治疗中的临床应用

Clinical study of platelet and D-dimer in the early bundle treatment of septic shock

目的探讨血小板、D-二聚体在感染性休克早期集束化治疗中的临床应用价值。方法随机选取成人综合ICU感染性休克患者60例，均予以早期集束化治疗。于集束化治疗前、治疗后6h，入ICU1、2、3、4、5d，分别检测血小板计数、D-二聚体浓度，并分别记录各时间点急性生理学和慢性健康状况评分系统II（APACHEII）评分。根据患者28d转归分为存活组与死亡组，比较两组不同时间点相关指标，并对本组内各时间点相关指标与集束化治疗前进行比较。分别将两组内血小板计数、D-二聚体浓度与APACHEII评分进行相关分析。结果存活组APACHEII评分、D-二聚体随着病情好转下降，死亡组则呈升高趋势；存活组血小板计数随着病情好转逐渐升高，而死亡组则逐渐下降。经Pearson相关分析，APACHEII评分与血小板计数呈负性相关（t=-0．862，P〈0．01），与D-二聚体浓度呈正相关（，=0．445，P〈0．01）。结论血小板计数、D-二聚体浓度可作为感染性休克治疗效果及预后的评价指标，与APACHEII评分结合，能更准确地评估感染性休克病情的严重程度及预后。

Objective To study the clinical application of platelet and D-dimer in the early bundle treatment of septic shock. Methods 60 cases of septic shock in adult comprehensive ICU who accepted early bundle treatment were selected randomly. Platelet count and D-dimer concentration were respectively tested before bundle treatment, 6 hours after bundle treatment, 1, 2, 3, 4, 5 d after entering ICU. APACHE II score was recorded respectively at different time points. Patients were divided into survival group and death group according to the outcome within 28 days. The related indexes at different time points between two groups were compared, and the indexes within the group were compared with the indexes before bundle treatment. Correlation analysis was respectively studied between platelet count, D-dimer concentration and APACHE II score within two groups. Results APACHE II score and D-dimer concentration declined with the improvement of the disease in survival group, and it was opposite in death group. Platelet count gradually went up with the improvement of the disease in survival group, and it was opposite in death group. Pearson correlation analysis showed that APACHE II score was negatively correlated with platelet count （r=-0.862, P 〈 0.01）, and positively correlated with D-dimer concentration （r=0.445）. Conclusion Platelet count and D-dimer concentration can be indexes to evaluate therapeutic effect and prognosis of septic shock, which can more accurately evaluate the severity and prognosis of septic shock when combined with APACHE II score.