高龄脓毒症患者凝血功能动态变化及与预后的关系
Relationship between the changes of coagulation function and prognosis in the oldest-old patients with sepsis LU Shui-huan, TANG Wei-xiong, Cai Zh-imei, LIU Xue-yuan. Department of Geriatrics, 181 Hospital of PLA, Guilin 541002, China

卢水焕,刘学员.高龄脓毒症患者凝血功能动态变化及与预后的关系[J].内科急危重症杂志,2016,22(5):

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英文关键词:oldest-old Sepsis Coagulopathy Prognosis

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作者	单位	E-mail
卢水焕	解放军第一八一医院	lushuihuan@126.com
刘学员	解放军第一八一医院	lxy37511@sohu.com

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中文摘要:

目的：探讨高龄脓毒症患者凝血功能动态变化趋势及其与预后的关系。方法：分析55例高龄脓毒症住院患者的临床资料,按此次脓毒症终点分为生存组和死亡组,分别于治疗0d、2d、4d、6d时检测血小板计数(PLT)、凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)和D-二聚体,并于治疗0d时以序贯器官衰竭估计(SOFA)量表进行评分。比较各时间点两组凝血参数变化及与预后的相关性。结果：高龄脓毒症住院患者病死率61.82%。组内分别比较,生存组患者治疗后的凝血参数较治疗0d时均无显著差异(P＞0.05)；死亡组患者治疗后的凝血参数分别与治疗0天时相比,治疗2d、4d时PLT下降,PT、APTT均延长,治疗6d时APTT延长,差异均具有统计学意义(P＜0.05)。两组间对应时间点分别比较,治疗0d时各凝血指标无差异(P＞0.05),死亡组患者在治疗2d时PT显著延长,治疗4d时PT、APTT显著延长；治疗6d时PT、APTT、TT显著延长,差异均具有统计学意义(P＜0.05)。经Logistic 回归分析,PT在治疗2d(OR=3.957,95%CI：1.006～2.386,P＜0.05)、6d(OR=4.159,95%CI：1.036～6.025,P＜0.05)均是与死亡相关的危险因素。结论：高龄脓毒症患者凝血功能动态变化趋势与预后有关,PT在病程中是死亡的危险因素之一,动态监测对及早判断预后有重要意义。

英文摘要:

Objective: To investigate the relationship between the changes of coagulation function and prognosis in the oldest-old patients with sepsis. Medthods: The clinical data of 55 oldest-old patients with sepsis were collected and analyzed. They were divided into the survival group and non-survival group in according to the end of sepsis. Planet(PLT)count, prothrombin time(PT), thrombin time(TT), activated partial thromboplastin time(APTT)and D-dimmer(DD)were respectively determined at day 0, 2, 4, 6 of treatment. And scored patients according to Sequential Organ Failure Assessment(SOFA )on day 0 of treatment. The differences of coagulation markers between the two groups were comprised and the relationship between the changes of coagulation parameters and prognosis were studied. Results: The mortality of septic oldest-old patients was 61.82%. The values of all coagulation parameters in survival group at day 2, 4, 6 were not significantly different compared with those at day 0(P＞0.05). But compared with all coagulation parameters at day 0 respectively in non-survival group, PLT were lower, PT and APTT were longer at day 2, 4 , APTT were also longer at day 6(P＜0.05). The values of PT of non-survival patients were significantly longer than those in survival patients at day 2, 4, 6. And APTT of non-survival patients were also significantly longer at day 4, 6(P＜0.05). TT in non-survival group were longer at day 6(P＜0.05).The results from Logistic regression analysis showed that PT was the factor significantly related with death at day 2(OR=3.957,95%CI：1.006～2.386,P＜0.05) and day 6(OR=4.159,95%CI：1.036～6.025,P＜0.05) of treatment. Conclusion: The changes of coagulation function in septic oldest-old patients are related to prognosis. PT is a risk factor of death and monitor its change is important for predicting the outcome in the septic oldest-old patients.