血栓弹力图与凝血参数对老年脓毒症患者病情严重程度和预后的评估价值研究

Study on the value of thromboelastogramand coagulation parameters in evaluating the severity and prognosis of elderly patients with sepsis

目的研究血栓弹力图(TEG)与凝血参数对老年脓毒症患者病情严重程度和预后的评估价值。方法回顾性分析2020年1月-2020年9月成都医学院第二附属医院o核工业四一六医院重症医学科收治的85例脓毒症老年患者的病例资料,根据急性生理学及慢性健康状况评分Ⅱ (APACHE Ⅱ)和序贯器官衰竭评分(SOFA),将患者分为脓毒症组(n=48)和脓毒症休克组(n=37),同时根据患者28 d的疾病转归情况分为存活组(n=65)和死亡组(n=20)。检测并比较各组凝血参数[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)与D-二聚体(DD)]和TEG参数[血凝时间(R)、血块成型时间(K)、α角、血块强度(MA)与凝血综合指数(CI)];分析TEG参数与凝血参数的相关性。结果脓毒症休克组的PT、APTT、DD、R与K值高于脓毒症组,α角、MA与CI值均低于脓毒症组(P<0.05);存活组PT、APTT、DD、R与K值低于死亡组,α角、MA与CI值高于死亡组(P<0.05);Spearman相关分析显示,PT、APTT、DD水平与R和K呈正相关,与α角、MA和CI呈负相关(P<0.05)。结论 TEG和凝血参数可判断老年脓毒症患者凝血纤溶状态,与脓毒症病情严重程度和预后有相关性,具有一定的临床参考价值。

Objective To study the value of thromboelastogram(TEG) and coagulation parameters in evaluating the severity and prognosis of elderly patients with sepsis.Methods The clinical data of 85 elderly patients with sepsis admitted to the Department of Critical Care Medicine of 416 Hospital of Nuclear Industry from January 2020 to September 2020 were analyzed retrospectively.According to Acute Physiology and Chronic Health Status Score Ⅱ(APACHE Ⅱ) and Sequential Organ Failure Score(SOFA),these patients were divided into sepsis group(n=48) and septic shock group(n=37).At the same time,they were divided into survival group(n=65) and death group(n=20) according to the disease outcome within 28 days.The coagulation parameters [activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),fibrinogen(FIB),D-dimer(DD)] and TEG parameters [coagulation time(R),clot forming time(K),α angle,maximum amplitude(MA),coagulation index(CI)] were detected and compared between the two groups.The correlation between TEG parameters and coagulation parameters was analyzed.Results The levels of PT,APTT,DD,R and K of the septic shock group were higher than those of the sepsis group,and the levels of α angle,MA and CI were lower than those of the sepsis group(P<0.05).The levels of PT,APTT,DD,R and K of the survival group were lower than those of the death group,and the levels of α angle,MA and CI were higher than those of the death group(P<0.05).Spearman correlation analysis showed that PT,APTT,DD levels were positively correlated with R and K,and negatively correlated with α angle,MA and CI(P<0.05).Conclusion TEG and coagulation parameters can be used to determine the coagulation and fibrinolysis status of elderly patients with sepsis.They are related to the severity and prognosis of sepsis,and have certain clinical reference value.