江西省重症患者凝血功能障碍诊疗现状的问卷调查

Questionnaire on Diagnosis and Treatment of Coagulation Dysfunction in Severe Patients in Jiangxi Province

目的对江西省重症患者凝血功能障碍诊疗现状进行问卷调查,旨在明确江西省重症监护病房(Inten⁃sive care unit,ICU)凝血功能障碍常见原因及监测手段,评价重症监护病房医师对凝血功能障碍的诊疗能力。方法2021年10月5日至12日对江西省二甲以上医院重症监护病房137名医师进行问卷调查,调查内容包括医师基本信息、凝血功能障碍常见原因、诊断与治疗能力三方面相关问题,并进行统计分析。结果被调查者三甲医院及综合ICU所占比例最高,本科以上学历者占98.5%。感染是ICU中发生血小板减少、凝血酶原时间、活化部分凝血酶原时间延长及弥散性血管内凝血(disseminate intravascular coagulation,DIC)的主要原因。接受调查的医院中血栓弹力图普及率为79.0%,51.8%的医师认为血栓弹力图是重症患者凝血功能诊断最有价值的项目,但仅有41.7%的医生熟练使用血栓弹力图。仍有33.3%的医师主要依靠临床经验诊断DIC。治疗脓毒症性DIC时,89.8%的医生认为需要进行抗凝治疗,54.6%的医师选择使用低分子肝素,但仅有14.6%的医师采用抗活化X因子(Xa)活性监测抗凝。结论感染是江西省ICU内凝血功能障碍的主要原因。江西省二甲以上医院ICU基本具备重症患者凝血功能障碍的诊疗条件,但在规范诊疗方面仍需加强培训。

Objective To clarify the common causes and evaluate the capability of diagnosis and treatment for coagulation dysfunction in intensive care units(ICUs)of Jiangxi Province by survey.Methods A questionnaire survey was conducted among 137 doctors in ICUs of Jiangxi Province in October,2021,including basic information of doctors,common causes of coagulation dysfunction,diagnostic and therapeutic capability.Statistical analysis was performed.Results Most of the respondents worked in comprehensive ICUs of the tertiary hospitals,98.5%of which had bachelor degree or above.Infection was the main cause of thrombocytopenia,prolongation of activated partial prothrombin time(APTT)and disseminated intravascular coagulation(DIC)in ICUs.Thromboelastography(TEG)was in use in the 79.0%surveyed hospitals.TEG was believed to be the most valuable item for the diagnosis of coagulation function in severe patients by 51.8%of doctors in this survey.However,only 41.7%of doctors were skilled in using TEG and 33.3%of doctors still diagnosed DIC mainly by clinical experience.When treating septic DIC,89.8%of doctors thought that anticoagulant therapy was needed.54.6%of doctors chose to use low molecular weight heparin,but only 14.6%of doctors monitored heparin/LMWH by anti⁃Xa activity.Conclusion Infection is the main cause of coagulation dysfunction in ICUs of Jiangxi Province.ICUs in hospitals of Jiangxi province satisfied the conditions for diagnosis and treatment of coagulation dysfunction in severe patients,but further training needs to be strengthened in standardized diagnosis and treatment.