临床医师对新型冠状病毒肺炎患者凝血相关事件认知的调查

Analysis of the Chinese clinicians'perceptions regarding coagulation-related events in patients with coronavirus disease

目的评估疫情初期一线医师对新型冠状病毒肺炎(COVID-19)患者凝血相关事件的认知情况。方法通过网络调查问卷进行数据收集,分别对受访者一般情况、凝血系统的关注与评估,以及深静脉血栓(DVT)和急性肺栓塞(APE)的评估、诊断和治疗情况进行统计分析。结果在回收的70份调查问卷中,所有受访者均认为关注COVID-19患者的凝血系统改变是非常必要的,且大多数受访者认为危重型和重型患者应常规进行凝血指标的检测,分别为100.00%、92.86%。75.71%的受访者进行了弥散性血管内凝血(DIC)评分,其中大部分受访者倾向应用2017中国DIC评分标准(34.29%)。大多数受访者所收治的COVID-19患者DVT和APE发生率均<5%,分别为84.29%、82.86%。分别有92.86%和82.86%的受访者进行了DVT的评估、筛查,大多数受访者更易选择机械联合药物的方式预防DVT(60.00%),应用最多的预防药物是低分子量肝素(54.29%)。结论临床医师已经注意到监测COVID-19患者的凝血系统变化是非常重要的,并且对于DVT和APE的评估与治疗相对规范。多数受访者所收治的患者DVT和APE的发生率很低,但大家对DIC诊断标准的选择差异很大。D-二聚体对于评估凝血系统改变是一项非常重要的指标,但纤溶过程在感染性疾病凝血功能障碍中的作用应重新审视。

Objective To assess the perceptions of the Chinese frontline senior clinicians regarding coagulation-related events in patients with coronavirus disease 19(COVID-19).Methods This survey assessed the perceptions of the Chinese clinicians regarding the coagulation function in patients with COVID-19 and the evaluation,diagnosis,and treatment of deep vein thrombosis(DVT)and acute pulmonary embolism(APE).Results In 70 returned surveys,all respondents agreed that coagulation required attention.Most clinicians believed that COVID-19 patients should be routinely examined for coagulation indicators,with 100%and 92.86%of the doctors reporting a need to monitor patients in critical and severe conditions,respectively.Among the respondents,75.71%believed the disseminated intravascular coagulation(DIC)score should be routinely measured,with 34.29%of whom preferring the 2017 Chinese DIC Scoring System(2017 CDSS).The DVT and APE incidence rates were<5%among the patients treated by most of the doctors(84.29%,82.86%,respectively).DVT assessment and screening were performed by 92.86%and 82.86%of the respondents respectively.Most respondents chose machinery and drugs for DVT prevention(60.00%),and low molecular-weight heparin for treatment(54.29%).Conclusions Most doctors believe that coagulation should be routinely monitored in COVID-19 patients,and assessment and treatment of DVT and APE should be standardized.Most respondents think the incidence of DVT and APE(<5%)yet significant differences are noted in the clinicians'choice of DIC diagnostic criteria.The D-dimer level is a significant factor for assessing coagulation change in COVID-19 patients.However,the role of fibrinolytic processes in coagulation disorders with infectious diseases should be reconsidered.