综合干预对重症急性胰腺炎患者凝血功能和下肢深静脉血栓形成的影响

Effect of comprehensive intervention on coagulation function and lower extremity deep vein thrombosis formation in patients with severe acute pancreatitis

目的探讨综合干预对重症急性胰腺炎(SAP)患者凝血功能和下肢深静脉血栓(DVT)形成的影响。方法收集2020年2月至2023年5月首都医科大学附属北京友谊医院收治的148例SAP患者的临床资料,根据入院后是否接受了综合干预将患者分为干预组(n=77,在常规治疗的基础上针对下肢DVT进行预防性综合干预)和对照组(n=71,按SAP诊疗常规给予治疗)。比较两组患者的SAP病情以及住院期间治疗情况、下肢DVT发生情况、凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)]、并发症发生情况。结果两组患者的SAP病因分布情况、改良Marshall评分、改良的计算机断层扫描(CT)严重指数评分、手术情况、机械通气情况及持续性肾脏替代治疗情况比较,差异均无统计学意义(P﹥0.05)。住院期间,干预组患者下肢DVT的发生率为2.6%(2/77),低于对照组患者的12.7%(9/71),差异有统计学意义(P﹤0.05)。出院之前复查凝血功能结果显示,两组患者的PT、APTT及INR比较,差异均无统计学意义(P﹥0.05)。住院期间,两组患者的并发症总发生率比较,差异无统计学意义(P﹥0.05)。结论综合干预可以有效降低SAP患者住院期间发生下肢DVT的风险,同时对SAP患者的凝血功能未产生明显的影响,也没有增加并发症的发生风险。

Objective To investigate the effect of comprehensive interventions on coagulation function and lower extremity deep vein thrombosis(DVT)formation in patients with severe acute pancreatitis(SAP).Method The clinical data of 148 SAP patients admitted to Beijing Friendship Hospital,Capital Medical University from February 2020 to May 2023 were collected,the patients were divided into intervention group(n=77,receiving preventive comprehensive intervention for lower extremity DVT on the basis of routine treatment)and control group(n=71,receiving treatment according to SAP diagnosis and treatment routine)based on whether they received comprehensive intervention after admission.The SAP condition,treatment during hospitalization,incidence of lower extremity DVT during hospitalization,coagulation function indicators[prothrombin time(PT),activated partial thromboplastin time(APTT),international normalized ratio(INR)]during hospitalization,and incidence of complications during hospitalization between two groups of patients were compared.Result There were no statistically significant differences in the distribution of SAP etiology,modified Marshall scores,modified computed tomography(CT)severity index score,surgery,mechanical ventilation,and continuous renal replacement therapy between the two groups of patients(P>0.05).During hospitalization,the incidence of lower extremity DVT in the intervention group was 2.6%(2/77),which was lower than the 12.7%(9/71)in the control group,and the difference was statistically significant(P<0.05).The results of the coagulation function re-examination before discharge showed that there were no statistically significant differences in the PT,APTT,and INR between the two groups of patients(P>0.05).During hospitalization,there was no statistically significant difference in the total incidence of complications between the two groups of patients(P>0.05).Conclusion Comprehensive intervention can effectively reduce the risk of lower extremity DVT in SAP patients during hospitalization.At the same time,it does not produce significant impact of coagulation function in SAP patients and does not increase the risk of complications.