肺部感染致脓毒症患者降钙素原与凝血功能变化及预后影响因素分析

Changes of Procalcitonin and Coagulation Function and Prognostic Factors of Patients with Sepsis Caused by Pulmonary Infection

目的:分析肺部感染致脓毒症患者降钙素原(PCT)与凝血功能变化及其预后影响因素。方法:选择2019年1月-2021年12月邹城市人民医院收治的肺部感染致脓毒症患者80例为观察组,另选取同期非脓毒症肺部感染患者40例为对照组,比较两组PCT、血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)。以死亡为预后研究终点事件对观察组患者进行28 d随访,随访终止,死亡患者为死亡组,生存患者为生存组,比较生存组及死亡组年龄、性别、基础疾病、PCT、PLT、PT、APTT、序贯性器官功能衰竭(SOFA)评分及急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、机械通气时间及氧合指数(PaO/FiO);多因素logistic回归分析肺部感染致脓毒症患者预后影响因素。结果:观察组PCT高于对照组,PLT低于对照组,PT、APTT均长于对照组,差异均有统计学意义(P<0.05)。随访结束,24例患者死亡,56例患者生存。生存组与死亡组年龄、PCT、PLT、PT、APTT、SOFA评分、APACHEⅡ评分、PaO/FiO差异均有统计学意义(P<0.05);性别、合并基础疾病、机械通气时间方面两组间差异均无统计学意义(P>0.05)。PT、APTT延长及PCT、SOFA评分、APACHEⅡ评分升高为患者预后独立危险因素,而PaO/FiO升高为保护因素(P<0.05),年龄、PLT并非预后独立影响因素(P>0.05)。结论:肺部感染致脓毒症患者存在PCT升高及凝血功能异常,PT、APTT延长及PCT、SOFA评分、APACHEⅡ评分升高提示预后不良,而PaO/FiO升高提示预后较好。

Objective:To analyze the changes of procalcitonin (PCT) and coagulation function and prognostic factors of patients with sepsis caused by pulmonary infection.Method:A total of 80 patients with sepsis caused by pulmonary infection treated in Zoucheng People’s Hospital from January 2019 to December 2021 were selected as the observation group,and 40 patients with non-sepsis pulmonary infection in the same period were selected as the control group.PCT,platelet count (PLT),prothrombin time (PT) and activated partial thromboplastin time (APTT) were compared between the two groups.The patients in the observation group were followed up for 28 days with death as the endpoint of the prognostic study.As follow-up was terminated,the dead patients were as the death group and the surviving patients were as the survival group.The age,gender,basic diseases,PCT,PLT,PT,APTT,sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score,mechanical ventilation time and oxygenation index (PaO/FiO) of the survival group and the death group were compared.Multivariate logistic regression was used to analyze the prognostic factors of patients with sepsis caused by pulmonary infection.Result:PCT in the observation group was higher than that in the control group,PLT was lower than that in the control group,and PT and APTT were longer than those in the control group (P<0.05).At the end of follow-up,24 patients died and 56 patients survived.There were significant differences in age,PCT,PLT,PT,APTT,SOFA score,APACHEⅡ score and PaO/FiObetween survival group and death group (P<0.05).There were no significant differences between the two groups in gender,basic diseases and mechanical ventilation time (P>0.05).The prolongation of PT and APTT and the increase of PCT,SOFA score and APACHEⅡ score were independent prognostic risk factors,while the increase of PaO/FiOwas protective factor (P<0.05).Age and PLT were not independent prognostic factors (P>0.05).Conclusion:Patients with sepsis caused by pulmonary infection have elevated PCT and abnormal coagulation function.The prolongation of PT and APTT and the increase of PCT,SOFA score and APACHEⅡ score suggest a poor prognosis,while the increase of PaO/ FiOindicates a better prognosis.