不同严重程度脓毒症患者血栓弹力图特点及预测价值

Characteristics of thrombelastography in patients with different severity of sepsis and their value in assessment of prognosis

目的探讨血栓弹力图在脓毒症患者病情严重程度以及预后等方面的相关性以及预测价值。方法回顾性分析2013年1月1日-2019年12月31日期间于上海市交通大学附属瑞金医院急诊ICU及急诊内科病房收治的147例脓毒症患者,入院24 h内行炎症指标及血栓弹力图检测,同时行APECHEⅡ评分,根据APACHEⅡ评分分为轻症组和重症组,观察不同组间血栓弹力图的差异;在脓毒症患者中分为死亡组和存活组,评价对脓毒症患者预后的判断价值。结果重度的脓毒症较轻度的脓毒症其α角减小(P=0.015)、K时间延长(P=0.015),最大血块强度增强(P=0.045)。脓毒症死亡组的K时间明显大于存活组的K时间。当K时间≥2.2 min时(敏感度为77.27%,特异度为95.20%)脓毒症发生死亡的风险最大(P<0.01);结论重度脓毒症患者表现明显的低凝状态,K时间对脓毒症患者的预后具有预判价值。

Objective To investigate the correlation and predictive value of thromboelastography(TEG)in the severity and prognosis of patients with sepsis.Methods Clinical data of 147 patients with sepsis admitted to Intensive Care Unit(ICU)of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2013 to December 2019 were retrospectively analyzed.Inflammation indicators and TEGt were performed within 24 h after admission,and APACHEⅡscore was evaluated.According to APACHEⅡscore,the patients were divided into the mild group and severe group.TEG indicators were compared between the two groups.Patients with sepsis were divided into the death group and survival group to assess the value of TEG for prognosis of patients with sepsis.Results Compared with patients with mild sepsis,patients with severe sepsis had lowerαangle(P=0.015),longer K time(P=0.015),and higher maximum amplitude(P=0.045).The K time of the death group was significantly longer than that of the survival group.When K time≥2.2 min(sensitivity 77.27%and specificity 95.2%),the risk of sepsis death was the highest(P<0.001).Conclusions Patients with severe sepsis show marked hypocoagulability,and K time has predictive value for the prognosis of patients with sepsis.