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目的:探讨脓毒性休克患者凝血指标变化与急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭估计(SOFA)评分及预后的关系。方法:采用病例对照研究,回顾分析2013-07-2015-05我院ICU收治的80例脓毒性休克患者,根据28d预后分为存活组(n=45)和死亡组(n=35)。入院24h内检测血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fib)及D-二聚体(D-D),并进行APACHEⅡ及SOFA评分。以同期50例健康体检者为对照组,评价各组间凝血指标变化与病情严重程度及预后的关系。结果:与对照组比较,死亡组PLT、Fib水平显著降低,PT、APTT、TT显著延长,D-D水平显著升高(均P<0.01);存活组PLT降低,PT、APTT延长,D-D水平升高(均P<0.01)。与存活组比较,死亡组TT显著延长,Fib水平显著降低(P<0.01)。死亡组APACHEⅡ及SOFA评分均显著高于存活组(P<0.01)。Logistic回归分析显示,TT(OR=1.089,95%CI:1.012~1.173,P=0.024)和APACHEⅡ评分(OR=1.142,95%CI:1.051~1.240,P=0.002)为脓毒性休克患者死亡独立危险因素。TT及Fib预测脓毒性休克患者死亡风险的最佳临界值分别为22s(95%CI:0.570~0.813,P=0.003)和2.35g/L(95%CI:0.595~0.834,P=0.001)。结论:脓毒性休克患者存在凝血功能紊乱,因此监测脓毒性休克患者凝血指标变化,对病情严重程度的判断及预后评估具有重要意义。
Objective: To investigate the relationship between changes of coagulation index and acute physiology and chronic health status Ⅱ (APACHE Ⅱ), sequential organ failure assessment (SOFA) score and prognosis in patients with septic shock. Methods: A case-control study was conducted retrospectively. Twenty patients with septic shock admitted to our hospital from July 2013 to May 2015 were divided into survival group (n = 45) and death group (n = 35) according to the prognosis of 28 days. PLT, PT, APTT, TT, Fib and D-dimer were measured 24h after admission. , And APACHE Ⅱ and SOFA scores. In the same period, 50 healthy people were used as the control group to evaluate the relationship between the changes of coagulation index and the severity and prognosis of each group. Results: Compared with the control group, the levels of PLT and Fib in the death group were significantly decreased, the levels of PT, APTT and TT were significantly prolonged and the levels of DD were significantly increased (all P <0.01); PLT, PT and APTT were prolonged and DD were increased (All P <0.01). Compared with the survival group, the death group TT was significantly prolonged, Fib levels were significantly lower (P <0.01). APACHEⅡ and SOFA scores in the death group were significantly higher than those in the surviving group (P <0.01). Logistic regression analysis showed that patients with septic shock died at independence (OR = 1.089,95% CI: 1.012-1.1723, P = 0.024) and APACHE II (OR = 1.142,95% CI: 1.051-1.240, P = 0.002) Risk factors. The best cut-offs for TT and Fib predicting the risk of death in patients with septic shock were 22 seconds (95% CI 0.570-0.813, P 0.003) and 2.35 g / L (95% CI 0.595-0.834, P 0.001). Conclusion: There is coagulation disorder in patients with septic shock. Therefore, it is important to monitor the changes of coagulation index in patients with septic shock and to judge the severity of the sepsis and prognosis.