新型冠状病毒肺炎危重症患者炎症反应及凝血功能异常分析与治疗体会

Analysis and treatment of inflammatory response and coagulation function abnormalities in critically ill patients with novel coronavirus pneumonia

目的通过对新型冠状病毒肺炎(NCP)危重症患者炎症因子及凝血因子检测结果进行统计分析,探讨临床治疗效果。方法收集湖北省仙桃市第一人民医院于2020年2月3日至2月27日收治的19例NCP危重症患者临床资料,统计分析患者的白细胞总数、中性粒细胞计数、淋巴细胞计数、超敏C反应蛋白(hs-CRP)、降钙素原(PCT)、D二聚体(D-Dimmer)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、凝血酶原时间(PT)、部分活化凝血活酶时间(APTT)、国际标准化比值(INR)、纤维蛋白原(Fib)、心肌钙蛋白I(cTnI)、N末端脑钠肽前体(NT-proBNP)等指标。给予抗病毒、抗炎、抗凝等治疗,并全程给予心理干预,观察治疗效果。结果NCP危重症患者早期白细胞总数、中性粒细胞计数、淋巴细胞计数、Hs-CRP、PCT、cTnI、NT-proBNP、D-Dimmer、PT、APTT在正常参考值范围内,发展为危重症时,淋巴细胞计数、Fib降低(P<0.05),白细胞总数、中性粒细胞计数及hs-CRP、PCT、D-Dimmer、PT、APTT、INR均升高(P<0.05),极少部分患者cTnI、NT-proBNP无异常。治疗好转的患者淋巴细胞计数升高(P<0.05),白细胞总数、中性粒细胞计数及hs-CRP、PCT、D-Dimmer、PT、APTT、INR均降低(P<0.05)。D-Dimmer与淋巴细胞计数呈负相关(r=-0.376,P=0.01),与LDH(r=0.52,P=0.00)、hs-CRP(r=0.38,P=0.00)、白细胞总数(r=0.62,P=0.01)、中性粒细胞计数(r=0.61,P=0.01)、PCT(r=0.44,P=0.01)、CK(r=0.41,P=0.005)、NT-proBNP(r=0.48,P=0.003)均呈正相关。相关性分析显示中性粒细胞计数(r=0.47,P=0.04)、PCT(r=0.49,P=0.03)与死亡呈正相关。NCP危重症患者汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)及自杀风险评估量表(NGASR)评分高,好转患者各项评分明显降低。结论NCP患者危重症时炎症反应及凝血功能明显异常,合并细菌感染增加死亡风险,根据D-二聚体变化给予适量抗凝治疗有助于控制病情,适时的抗感染治疗及激素应用和全程的心理疏导对NCP危重症患者治疗有积极作用。

Objective Through statistical analysis of the detection results of inflammatory factors and coagulation factors in critically ill patients with novel coronavirus pneumonia(Novel coronavirus pneumonia,NCP),the clinical treatment effect was explored.Methods The clinical data of 19 critically ill patients with NCP who were admitted to the First People's Hospital of Xiantao City,Hubei Province from February 3 to February 27,2020 were collected,and the total number of white blood cells,neutrophil count,lymphocyte count and hypersensitivity C were statistically analyzed.Reactive protein(hs-CRP),procalcitonin(PCT),D-dimer(D-Dimmer),lactate dehydrogenase(LDH),creatine kinase(CK),prothrombin time(PT),part Activated thromboplastin time(APTT),international normalized ratio(INR),fibrinogen(Fib),cardiac troponin I(cTnI),amino nitrogen-terminal precursor brain natriuretic peptide(NT-proBNP)and other indicators.The patients were given anti-viral,anti-inflammatory,and anticoagulant treatments,and psychological intervention was given throughout the process to observe the treatment effect.Results The total number of early white blood cells,neutrophil count,lymphocyte count,Hs-CRP,PCT,cTnI,NT-proBNP,D-Dimmer,PT,APTT in critically ill patients with NCP were within the normal reference range.When developing critical illness,lymphocyte count and Fib decreased(P<0.05),total white blood cell count,neutrophil count,hs-CRP,PCT,D-Dimmer,PT,APTT,INR increased(P<0.05).Very few patients have no abnormalities in cTnI and NT-proBNP.The lymphocyte count of patients who improved after treatment increased(P<0.05),and the total number of white blood cells,neutrophil count,hs-CRP,PCT,D-Dimmer,PT,APTT,and INR decreased(P<0.05).D-Dimmer was negatively correlated with lymphocyte count(r=-0.376,P=0.01),and with LDH(r=0.52,P=0.00),hs-CRP(r=0.38,P=0.00),total number of white blood cells(r=0.62,P=0.01),neutrophil count(r=0.61,P=0.01),PCT(r=0.44,P=0.01),CK(r=0.41,P=0.005),NT-proBNP(r=0.48,P=0.003)are positively correlated.Correlation analysis showed that neutrophil count(r=0.47,P=0.04)and PCT(r=0.49,P=0.03)were positively correlated with death.The scores of Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD)and Suicide Risk Assessment Scale(NGASR)were high in critically ill patients with NCP,and the scores of improved patients were significantly reduced.Conclusion The inflammatory response and blood coagulation function of NCP patients are obviously abnormal when they are critically ill,and bacterial infections increase the risk of death.According to the changes of D-dimer,the appropriate amount of anticoagulant therapy can help control the disease.Timely anti-infective treatment,hormone application and whole-course psychological counseling have a positive effect on the treatment of critically ill patients with NCP.