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目的研究慢性肺源性心脏病急性加重期(AECCP)患者血液凝固状态与动脉血气的相关性及其对预后的影响,并探讨其可能机制。方法对AECCP住院患者血小板计数(Plt)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、凝血酶时间(TT)的水平和动脉血酸碱度(p H)、氧分压(Pa O2)、二氧化碳分压(Pa CO2)、实际碳酸氢根(HCO-3)作回顾性分析,并与30例正常人比较,探讨AECCP患者血液凝固状态与动脉血气的量变关系及其对预后的影响。结果患者PT、APTT、Fib、TT水平高于正常人(P<0.001);呼吸衰竭发生率为72.3%,其中Ⅰ型呼吸衰竭19.0%,低于Ⅱ型呼吸衰竭(53.3%)(P<0.001);酸血症发生率为37.9%,高于碱血症(10.8%)(P<0.001);死亡组p H、Plt水平低于生存组(P<0.05);Pa CO2、HCO-3水平高于生存组(P<0.01,P<0.05);p H、Plt预计患者生存机会的ROC曲线下面积(AUC)分别为0.641(95%CI:0.536~0.745;P<0.01)和0.620(95%CI:0.523~0.718;P<0.05);Pa CO2、HCO-3预计死亡风险的ROC曲线AUC分别为0.634(95%CI:0.534~0.734;P<0.01)和0.625(95%CI:0.524~0.727;P<0.05)。p H与Plt水平呈正相关,与Pa CO2、HCO-3水平呈负相关;Plt与Fib呈正相关,与PT呈负相关。结论易栓状态、出血倾向、低氧血症、高碳酸血症和酸中毒通常同时存在于AECCP患者当中;凝血功能紊乱和呼吸功能障碍严重程度密切相关;Plt、p H、Pa CO2、HCO-3水平可作为判断AECCP患者预后的指标。
Objective To study the correlation between blood coagulation status and arterial blood gas in patients with acute exacerbation of chronic cor pulmonale (AECCP) and its effect on prognosis and to explore its possible mechanism. Methods The levels of platelet count (Plt), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), thrombin time (TT) and arterial pH H, PaO2, PaCO2, and HCO3-3 were measured retrospectively and compared with 30 normal subjects to investigate the relationship between blood coagulation and arterial blood gas in patients with AECCP Quantitative relationship and its impact on prognosis. Results The levels of PT, APTT, Fib and TT were higher than those in normal controls (P <0.001). The incidence of respiratory failure was 72.3%, of which 19.0% was type Ⅰ respiratory failure, lower than that of type Ⅱ respiratory failure (53.3%) ); The incidence of acidosis was 37.9%, higher than that of alkali (10.8%) (P <0.001); the levels of p H and Plt in death group were lower than those in survival group (P <0.05) (P <0.01, P <0.05). The area under the ROC curve (p0.01) and the area under the ROC curve (p0.01) of p H and Plt were 0.664 (95% CI 0.536-0.745; % CI: 0.523-0.718; P <0.05). The AUC of the expected risk of death of PaCO 2 and HCO-3 were 0.634 (95% CI 0.534-0.734; 0.727; P <0.05). There was a positive correlation between p H and Plt levels and a negative correlation with PaCO 2 and HCO 3 levels. Plt was positively correlated with Fib and negatively correlated with PT. CONCLUSIONS: The easiness of embolism, bleeding tendency, hypoxemia, hypercapnia and acidosis usually exist in AECCP patients at the same time. The coagulation disorder is closely related to the severity of respiratory dysfunction. Plt, p H, Pa CO2, HCO- 3 levels can be used as indicators to judge the prognosis of AECCP patients.