重症肺炎患者凝血功能情况和预后的影响因素分析

Analysis of factors influencing coagulation function and prognosis of severe pneumonia patients

目的探讨重症肺炎患者凝血功能情况和预后的影响因素。方法选择2017年2月~2019年12月医院收治的重症肺炎患者及普通肺炎患者的资料进行回顾性分析。依据全部患者的入院诊断分为重症肺炎组(n=53)和普通肺炎组(n=60)。根据重症肺炎患者的转归分为存活组与死亡组。重症肺炎组和普通肺炎组的性别、年龄、体质量指数、凝血指标[纤维蛋白原(Fib)、凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、D-二聚体]。比较死亡组和存活组的年龄、性别、体质量指数、合并基础疾病(种)、凝血指标[Fib、PT、TT、APTT、D-二聚体]、APACHEⅡ评分、MODS评分、病变累及器官数量、卧床时间、清蛋白、白细胞计数、机械通气。通过单因素分析以及多因素分析,探讨重症肺炎患者预后的影响因素。结果重症肺炎组的Fib、PT、TT、APTT、D-二聚体均高于普通肺炎组(P<0.05)。年龄、Fib、PT、TT、APTT、D-二聚体、APACHEⅡ评分、MODS评分、病变累及器官数量、是否采用机械通气、卧床时间均为重症肺炎患者预后的独立影响因素(P<0.05)。结论重症肺炎患者存在非常明显的凝血指标异常,多种因素均对重症肺炎患者的预后构成影响,在实际工作中需要进行针对性的干预。

Objective To explore the factors influencing coagulation function and prognosis of severe pneumonia patients.Methods Retrospective analysis was conducted on the data of severe pneumonia patients and common pneumonia patients admitted to the hospital from February 2017 to December 2019.All patients were divided into severe pneumonia group(n=53)and common pneumonia group(n=60)according to their admission diagnosis.According to their outcome,severe pneumonia patients were divided into survival group and death group.Sex,age,body mass index(BMI),coagulation indexes(fibrinogen(Fib),prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),and D-dimer)were compared between the severe pneumonia group and the common pneumonia group.The age,sex,BMI,combined underlying diseases(species),coagulation indexes(Fib,PT,TT,APTT,and D-dimer),APACHEⅡscore,MODS score,number of organs involved in the disease,bed time,albumin,white blood cell count,and mechanical ventilation were compared between the death group and the survival group.Through univariate analysis and multivariate analysis,the factors influencing the prognosis of severe pneumonia patients were discussed.Results Fib,PT,TT,APTT and D-dimer in severe pneumonia group were all higher than those in common pneumonia group(P<0.05).Age,Fib,PT,TT and APTT,D-dimer,APACHEII score,MODS score,number of organs involved in the disease,whether to adopt mechanical ventilation,bed time were all independent impact factors for the prognosis of severe pneumonia patients(P<0.05).Conclusion Severe pneumonia patients have very obvious abnormal coagulation indexes,and many factors have an impact on their prognosis.Therefore,pertinent intervention is needed in practical work.