目的探讨国际血栓与止血协会(The International Society of Thrombisis and Hemostasis,ISTH)评分标准、日本急诊医学学会(Japanese Association for Acute Medicin,JAAM)、评分标准和中国弥散性血管内凝血诊断积分系统(Cheinese disse...目的探讨国际血栓与止血协会(The International Society of Thrombisis and Hemostasis,ISTH)评分标准、日本急诊医学学会(Japanese Association for Acute Medicin,JAAM)、评分标准和中国弥散性血管内凝血诊断积分系统(Cheinese disseminated intravascular coagulation scoring,CDICS)三种弥漫性血管内凝血(disseminated intravascular coagulation,DIC)评分在评估脓毒性休克患者器官功能损伤和预后评估中的应用价值。方法回顾性分析96例脓毒性休克患者,记录临床资料及28d病死率,进行ISTH评分、JAAM评分及CDICS评分,并分为DIC组和非DIC(NODIC)组,分析两组器官功能损伤、危重程度及预后的差异。结果①脓毒性休克患者中,生存组的ISTH评分低于死亡组,分别为3(2,5)和4(3,6),差异有统计学意义(P=0.049);但生存组和死亡组的JAAM评分、CDICS评分差异均无统计学意义(P>0.05);②脓毒性休克患者中,ISTH评分、JAAM评分、CDICS评分与APACHEⅡ评分、SOFA评分均具有一定的相关性,r值分别为0.335、0.434、0.444(vs.APACHEⅡ评分)和0.443、0.559、0.632(vs.SOFA评分);③以不同DIC评分为DIC诊断标准,DIC组和NODIC组死亡构成比差异无统计学意义(P>0.05),但DIC组的危重度(APACHEⅡ评分)和器官功能损伤程度(SOFA评分)均明显高于NODIC组(P<0.05);④采用ROC曲线分析三种DIC评分预测脓毒性休克28d病死率,曲线下面积分别为0.626、0.578、0.613。结论ISTH评分、JAAM评分、CDICS评分有助于评估脓毒性休克患者的器官功能损伤和危重程度,但对28d病死率的预测价值欠佳,CDICS评分应用于脓毒性休克时与ISTH评分、JAAM评分具有类似的评估价值。展开更多
目的探讨弥散性血管内凝血(disseminated intravascular coagulation,DIC)国际血栓和止血学会(International Society of Thrombosis and Hemostasis criteria,ISTH)评分系统联合血清胱抑素C对重症肺炎患者急性肾损伤的临床价值。方法...目的探讨弥散性血管内凝血(disseminated intravascular coagulation,DIC)国际血栓和止血学会(International Society of Thrombosis and Hemostasis criteria,ISTH)评分系统联合血清胱抑素C对重症肺炎患者急性肾损伤的临床价值。方法回顾性分析2014年10月至2018年10月四川大学华西广安医院收治的153例重症肺炎患者的病例资料,根据是否合并急性肾损伤将患者分为急性肾损伤组(n=51)与非急性肾损伤组(n=102)。采用酶联免疫吸附法检测患者血清胱抑素C水平,比较两组患者的ISTH评分及血清胱抑素C水平,并通过受试者工作特征曲线(receiver operator characteristic curve,ROC)和曲线下面积评价ISTH联合血清胱抑素C、ISTH评分以及C反应蛋白对重症肺炎患者急性肾损伤的评估价值,用logistic回归分析重症肺炎患者急性肾损伤预后因素。结果急性肾损伤组的住院病死率、住院时间、序贯器官衰竭评分、急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluation scoring systemⅡ,APACHEⅡ)评分、平均动脉压、休克发生率以及白细胞计数、降钙素原水平、体温等感染炎性指标均明显高于非急性肾损伤组(P<0.05),ISTH评分、血清胱抑素C水平明显高于非急性肾损伤组(P<0.05)。在重症肺炎急性肺损伤患者中ISTH评分联合血清胱抑素C的ROC曲线下面积高于ISTH评分及血清胱抑素C的ROC曲线下面积,且敏感值、约登指数也较高。Logistic回归分析显示,年龄>60岁(OR=1.21,95%CI:0.90~1.61)、ISTH评分>3.6分(OR=3.40,95%CI:2.24~5.18)、血清胱抑素C>3.2mg/L(OR=3.76,95%CI:2.27~6.24)为重症肺炎急性肾损伤患者的预后危险因素。结论 ISTH评分联合血清胱抑素C对重症肺炎患者的急性肾损伤具有重要的临床价值。展开更多
目的目前在热射病诊治中应用的评分量表一般为借鉴其他专科量表形成。尚未有针对热射病经大规模临床试验验证的评分系统。文中就常用的急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、...目的目前在热射病诊治中应用的评分量表一般为借鉴其他专科量表形成。尚未有针对热射病经大规模临床试验验证的评分系统。文中就常用的急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、弥漫性血管内凝血(dissolved inorganic carbon,DIC)评分、多器官衰竭(multiple organ dysfunction,MODS)评分对热射病患者预后的评估价值进行比较,以及对3种评分加和、3种评分除权加和对热射病患者预后的评估价值进行比较,探寻较高临床应用价值的评分方法。方法对43名收住神经科重症监护室以及重症监护室诊断为热射病的危重患者分别进行APACHEⅡ、MODS评分、DIC评分及3种评分加和、3种评分除权加和分析。对5种得分进行受试者工作曲线(ROC)下面积分析。结果 3种评分除权加和具有最大的ROC曲线下面积0.896;MODS评分最佳截断点处敏感度72.7%、特异度99.69%;DIC评分最佳截断点处敏感度100%、特异度56.2%;3种评分除权加和最佳截断点处敏感度72.7%、特异度100%。结论 APACHEⅡ、MODS评分、DIC评分以及3种评分加和、3种评分除权加和的方法均可较好预测热射病患者预后,但判断预后的价值仍有欠缺,临床上亟需开发一种针对性更强的评分系统。展开更多
Objectives: The aim of this study is to introduce protocols for choosing trans-arterial embolization (TAE) or surgical hemostasis as an initial therapy for obstetric hemorrhage. Materials and Methods: From 2002 to 201...Objectives: The aim of this study is to introduce protocols for choosing trans-arterial embolization (TAE) or surgical hemostasis as an initial therapy for obstetric hemorrhage. Materials and Methods: From 2002 to 2011 at our hospital, the medical records of the patients who underwent TAE or surgical hemostasis for obstetric hemorrhage were reviewed to assess the following data: The causes of obstetric hemorrhage, Shock Index (SI) and obstetrical disseminated intra-vascular coagulation (DIC) score, amount of bleeding, transfusion, and operation time. Results: Twenty-five patients underwent TAE and six underwent surgical hemostasis. SI and obstetrical DIC score of the TAE group were 1.0 (0.4 - 2.2) and 6.0 (1 - 32), respectively. They were significantly lower than those of the surgical hemostasis group (SI: 1.6, obstetrical DIC score: 12.5, p < 0.05). Though the hemorrhage could be controlled sufficiently in 23 cases of the TAE group, 5 cases went into shock during TAE. The SI and obstetrical DIC score of shock group were 1.2 (1 - 2) and 10 (2 - 32), respectively. Conclusion: Though TAE is a useful therapy to control obstetric inevitable hemorrhage, special attention should be paid to the vital signs during TAE, especially in cases where SI and/or obstetrical DIC score are higher than 1.2 and 10, respectively.展开更多
<strong>Background: </strong>Disseminated Intravascular Coagulation (DIC) is a life threatening complication frequently observed in acute leukemia. Among the morphological varieties of Acute Myeloid Leukae...<strong>Background: </strong>Disseminated Intravascular Coagulation (DIC) is a life threatening complication frequently observed in acute leukemia. Among the morphological varieties of Acute Myeloid Leukaemia (AML), Acute Promyelocytic Leukaemia (APL) is well established to cause DIC. But there have been reports noted that abnormal DIC parameters also commonly observed in the patients with non-APL AML. This study evaluated the DIC parameters & DIC score according to International Society of Thrombosis and Haemostasis (ISTH) in newly diagnosed non-APL AML patients. <strong>Materials and Methods:</strong> This cross-sectional observational study was conducted in the Department of Haematology, BSMMU, Dhaka, Bangladesh. 48 newly diagnosed non-APL AML patients were enrolled. Platelets count was measured by auto analyzer (Sysmax XT 2000i/Pentra ABX-120DX) as well as checked manually. Prothrombin time, fibrinogen, D-Dimer were measured using STAGO Coagulation analyzer. The ISTH-DIC scoring system was used to calculate DIC score. The statistical analysis was carried out using the Statistical Package for Social Sciences version 24.0 for Windows. Chi-Square test & Fisher exact test was used for categorical variables. Unpaired t-test was used to compare mean between groups. For all statistical tests, p-value less than 0.05 was considered as statistically significant. <strong>Results: </strong>By analyzing 48 newly diagnosed patients with non-APL AML, found that DIC developed in 14.6% patients at presentation. Among the DIC parameters, PT and D-dimer were significantly higher in patients presented with DIC. Patients with DIC exhibit lower expression of CD117, CD34, HLA-DR and statistically significant association with negative expression of HLA-DR (p-value 0.034). No significant association was found between presence of DIC and age, gender, bleeding at presentation, morphological type, WBC count or peripheral blast percentage.<strong> Conclusion:</strong> Abnormalities of DIC parameters in common in patients with AML. A significant portion of patients with DIC have no apparent symptom or bleeding. So, routine screening of DIC parameter at presentation is recommended for early diagnosis & effective management of DIC.展开更多
文摘目的探讨国际血栓与止血协会(The International Society of Thrombisis and Hemostasis,ISTH)评分标准、日本急诊医学学会(Japanese Association for Acute Medicin,JAAM)、评分标准和中国弥散性血管内凝血诊断积分系统(Cheinese disseminated intravascular coagulation scoring,CDICS)三种弥漫性血管内凝血(disseminated intravascular coagulation,DIC)评分在评估脓毒性休克患者器官功能损伤和预后评估中的应用价值。方法回顾性分析96例脓毒性休克患者,记录临床资料及28d病死率,进行ISTH评分、JAAM评分及CDICS评分,并分为DIC组和非DIC(NODIC)组,分析两组器官功能损伤、危重程度及预后的差异。结果①脓毒性休克患者中,生存组的ISTH评分低于死亡组,分别为3(2,5)和4(3,6),差异有统计学意义(P=0.049);但生存组和死亡组的JAAM评分、CDICS评分差异均无统计学意义(P>0.05);②脓毒性休克患者中,ISTH评分、JAAM评分、CDICS评分与APACHEⅡ评分、SOFA评分均具有一定的相关性,r值分别为0.335、0.434、0.444(vs.APACHEⅡ评分)和0.443、0.559、0.632(vs.SOFA评分);③以不同DIC评分为DIC诊断标准,DIC组和NODIC组死亡构成比差异无统计学意义(P>0.05),但DIC组的危重度(APACHEⅡ评分)和器官功能损伤程度(SOFA评分)均明显高于NODIC组(P<0.05);④采用ROC曲线分析三种DIC评分预测脓毒性休克28d病死率,曲线下面积分别为0.626、0.578、0.613。结论ISTH评分、JAAM评分、CDICS评分有助于评估脓毒性休克患者的器官功能损伤和危重程度,但对28d病死率的预测价值欠佳,CDICS评分应用于脓毒性休克时与ISTH评分、JAAM评分具有类似的评估价值。
文摘目的探讨弥散性血管内凝血(disseminated intravascular coagulation,DIC)国际血栓和止血学会(International Society of Thrombosis and Hemostasis criteria,ISTH)评分系统联合血清胱抑素C对重症肺炎患者急性肾损伤的临床价值。方法回顾性分析2014年10月至2018年10月四川大学华西广安医院收治的153例重症肺炎患者的病例资料,根据是否合并急性肾损伤将患者分为急性肾损伤组(n=51)与非急性肾损伤组(n=102)。采用酶联免疫吸附法检测患者血清胱抑素C水平,比较两组患者的ISTH评分及血清胱抑素C水平,并通过受试者工作特征曲线(receiver operator characteristic curve,ROC)和曲线下面积评价ISTH联合血清胱抑素C、ISTH评分以及C反应蛋白对重症肺炎患者急性肾损伤的评估价值,用logistic回归分析重症肺炎患者急性肾损伤预后因素。结果急性肾损伤组的住院病死率、住院时间、序贯器官衰竭评分、急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluation scoring systemⅡ,APACHEⅡ)评分、平均动脉压、休克发生率以及白细胞计数、降钙素原水平、体温等感染炎性指标均明显高于非急性肾损伤组(P<0.05),ISTH评分、血清胱抑素C水平明显高于非急性肾损伤组(P<0.05)。在重症肺炎急性肺损伤患者中ISTH评分联合血清胱抑素C的ROC曲线下面积高于ISTH评分及血清胱抑素C的ROC曲线下面积,且敏感值、约登指数也较高。Logistic回归分析显示,年龄>60岁(OR=1.21,95%CI:0.90~1.61)、ISTH评分>3.6分(OR=3.40,95%CI:2.24~5.18)、血清胱抑素C>3.2mg/L(OR=3.76,95%CI:2.27~6.24)为重症肺炎急性肾损伤患者的预后危险因素。结论 ISTH评分联合血清胱抑素C对重症肺炎患者的急性肾损伤具有重要的临床价值。
文摘目的目前在热射病诊治中应用的评分量表一般为借鉴其他专科量表形成。尚未有针对热射病经大规模临床试验验证的评分系统。文中就常用的急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、弥漫性血管内凝血(dissolved inorganic carbon,DIC)评分、多器官衰竭(multiple organ dysfunction,MODS)评分对热射病患者预后的评估价值进行比较,以及对3种评分加和、3种评分除权加和对热射病患者预后的评估价值进行比较,探寻较高临床应用价值的评分方法。方法对43名收住神经科重症监护室以及重症监护室诊断为热射病的危重患者分别进行APACHEⅡ、MODS评分、DIC评分及3种评分加和、3种评分除权加和分析。对5种得分进行受试者工作曲线(ROC)下面积分析。结果 3种评分除权加和具有最大的ROC曲线下面积0.896;MODS评分最佳截断点处敏感度72.7%、特异度99.69%;DIC评分最佳截断点处敏感度100%、特异度56.2%;3种评分除权加和最佳截断点处敏感度72.7%、特异度100%。结论 APACHEⅡ、MODS评分、DIC评分以及3种评分加和、3种评分除权加和的方法均可较好预测热射病患者预后,但判断预后的价值仍有欠缺,临床上亟需开发一种针对性更强的评分系统。
文摘Objectives: The aim of this study is to introduce protocols for choosing trans-arterial embolization (TAE) or surgical hemostasis as an initial therapy for obstetric hemorrhage. Materials and Methods: From 2002 to 2011 at our hospital, the medical records of the patients who underwent TAE or surgical hemostasis for obstetric hemorrhage were reviewed to assess the following data: The causes of obstetric hemorrhage, Shock Index (SI) and obstetrical disseminated intra-vascular coagulation (DIC) score, amount of bleeding, transfusion, and operation time. Results: Twenty-five patients underwent TAE and six underwent surgical hemostasis. SI and obstetrical DIC score of the TAE group were 1.0 (0.4 - 2.2) and 6.0 (1 - 32), respectively. They were significantly lower than those of the surgical hemostasis group (SI: 1.6, obstetrical DIC score: 12.5, p < 0.05). Though the hemorrhage could be controlled sufficiently in 23 cases of the TAE group, 5 cases went into shock during TAE. The SI and obstetrical DIC score of shock group were 1.2 (1 - 2) and 10 (2 - 32), respectively. Conclusion: Though TAE is a useful therapy to control obstetric inevitable hemorrhage, special attention should be paid to the vital signs during TAE, especially in cases where SI and/or obstetrical DIC score are higher than 1.2 and 10, respectively.
文摘<strong>Background: </strong>Disseminated Intravascular Coagulation (DIC) is a life threatening complication frequently observed in acute leukemia. Among the morphological varieties of Acute Myeloid Leukaemia (AML), Acute Promyelocytic Leukaemia (APL) is well established to cause DIC. But there have been reports noted that abnormal DIC parameters also commonly observed in the patients with non-APL AML. This study evaluated the DIC parameters & DIC score according to International Society of Thrombosis and Haemostasis (ISTH) in newly diagnosed non-APL AML patients. <strong>Materials and Methods:</strong> This cross-sectional observational study was conducted in the Department of Haematology, BSMMU, Dhaka, Bangladesh. 48 newly diagnosed non-APL AML patients were enrolled. Platelets count was measured by auto analyzer (Sysmax XT 2000i/Pentra ABX-120DX) as well as checked manually. Prothrombin time, fibrinogen, D-Dimer were measured using STAGO Coagulation analyzer. The ISTH-DIC scoring system was used to calculate DIC score. The statistical analysis was carried out using the Statistical Package for Social Sciences version 24.0 for Windows. Chi-Square test & Fisher exact test was used for categorical variables. Unpaired t-test was used to compare mean between groups. For all statistical tests, p-value less than 0.05 was considered as statistically significant. <strong>Results: </strong>By analyzing 48 newly diagnosed patients with non-APL AML, found that DIC developed in 14.6% patients at presentation. Among the DIC parameters, PT and D-dimer were significantly higher in patients presented with DIC. Patients with DIC exhibit lower expression of CD117, CD34, HLA-DR and statistically significant association with negative expression of HLA-DR (p-value 0.034). No significant association was found between presence of DIC and age, gender, bleeding at presentation, morphological type, WBC count or peripheral blast percentage.<strong> Conclusion:</strong> Abnormalities of DIC parameters in common in patients with AML. A significant portion of patients with DIC have no apparent symptom or bleeding. So, routine screening of DIC parameter at presentation is recommended for early diagnosis & effective management of DIC.
