急诊感染患者凝血障碍与脓毒血症的关系及参考评价

Relationship between coagulopathy and sepsis in patients with acute infection and its reference value

目的探讨急诊感染患者凝血障碍与脓毒血症之间的关系及其参考价值。方法选取2014年1月-2015年12月期间医院收治的128例急性感染患者作为临床研究对象,根据全身炎症反应综合征评分及序贯器官衰竭评分将患者随机分为单纯感染组46例、脓毒血症组50例、重度脓毒血症组32例,并分别对三组急诊感染患者的死亡情况、凝血指标变化情况、抗凝指标变化情况、炎症指标变化情况进行比较和分析。结果与单纯感染组病死率6.52%、脓毒血症组病死率10.00%比较,重度脓毒血症组的病死率上升为34.38%,差异有统计学意义(P<0.05);与单纯感染组、脓毒血症组比较,重度脓毒血症组的血小板计数(PLT)和D-二聚体均升高,差异有统计学意义(P<0.05);与单纯感染组、脓毒血症组比较,重度脓毒血症组的抗凝血酶Ⅲ抗体(AT-Ⅲ)、活化蛋白C(APC)均明显降低,差异有统计学意义(P<0.05);与单纯感染组、脓毒血症组比较,重度脓毒血症组的C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)均升高,差异有统计学意义(P<0.05)。结论急诊感染患者凝血障碍与脓毒血症严重程度密切相关,对凝血功能的检测必将为准确判断患者脓毒血症病情的严重程度提供具有价值的参考。

OBJECTIVE To probe into the relationship between coagulopathy and sepsis in patients with acute infection and its reference value.METHODS A total of 128 patients with acute infections in the hospital from Jan.2014 to Dec.2015 were selected as clinical study object.All the patients were divided into simple infection group（46 cases）,sepsis group（50 cases）,and severe sepsis group（32 cases）according to the systemic inflammatory response syndrome score and sequential organ failure score.The mortality,changes of coagulation indexes,anticoagulation index and inflammatory indexes of the emergency patients from the three groups were compared and analyzed.RESULTS Compared with simple infection group（6.52%）and sepsis group（10.00%）,the mortality of severe sepsis group was significantly increased to 34.38%（P〈0.05）.Compared with simple infection group and sepsis group,the levels of platelet count（PLT）and D-dimer of severe sepsis group were increased significantly（P〈0.05）.Compared with simple infection group and sepsis group,the levels of antithrombin III antibody（AT-Ⅲ）and activated protein C（APC）of severe sepsis group were decreased significantly（P〈0.05）.Compared with simple infection group and sepsis group,the levels of C-reactive protein（CRP）and tumor necrosis factor-α（TNF-α）of severe sepsis group were increased significantly（P〈0.05）.CONCLUSIONCoagulation disorder in patients with acute infection is closely related to the severity of sepsis.The detection of coagulation function will provide a valuable reference for accurately assessing the severity of sepsis in patients.