| 唐永军,姚丽丹,张煜华,张红玉,迪力木拉提·依斯热依力.脓毒症患者发生凝血功能紊乱的临床特征及预后影响因素分析[J].,2024,(2):268-273 |
| 脓毒症患者发生凝血功能紊乱的临床特征及预后影响因素分析 |
| To Analyze the Clinical Characteristics and Prognostic Factors of Coagulation Disorders in Patients with Sepsis |
| 投稿时间：2023-03-27 修订日期：2023-04-23 |
| DOI：10.13241/j.cnki.pmb.2024.02.012 |
| 中文关键词: 脓毒症 凝血功能异常 临床特征 预后 |
| 英文关键词: Sepsis Abnormal coagulation function Clinical features Prognosis |
| 基金项目:新疆维吾尔自治区自然科学基金项目（2021D01C361） |
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| 中文摘要: |
| 摘要 目的：探究脓毒症患者发生凝血功能紊乱的临床特征及预后影响因素。方法：选择2019年9月~2023年1月本院收治的80例脓毒症患者为本次研究对象，对所有患者开展凝血功能检验，并依据检验结果，将患者分为凝血功能异常组（n=60）及正常组（n=20），分析凝血功能障碍异常及正常患者临床特征、凝血功能障碍异常及正常患者病情严重程度，并依据脓毒症患者预后，将其分为存活组（n=64）及死亡组（n=16）脓毒症患者预后的单因素与多因素Logistic回归分析。结果：凝血功能正常组及异常组平均动脉压、体温、白细胞计数（WBC）、纤维蛋白原（FIB）、凝血酶时间（TT）指标水平无较大差异（P＞0.05），与凝血功能正常组比较，凝血功能异常组患者呼吸、脉率、降钙素原（PCT）、C反应蛋白（CRP）指标水平相对较高，部分凝血活酶时间（APTT）、凝血酶原时间（PT）指标水平相对较长，PLT指标水平相对较高（P＜0.05）；与凝血功能正常的脓毒症患者相比较，凝血功能异常患者急性肾损伤（AKI）及急性呼吸窘迫综合征（ARDS）发生率、急性生理与慢性健康评分（APACHE Ⅱ）及急性生理功能评分（SOFA）评分更高，住ICU时间均相对较长（P＜0.05），机械通气及住院时间比较（P＞0.05）；脓毒症患者预后影响因素分析中，结果显示，年龄、体质量指数（BMI）、性别、糖尿病史、高血压病史均未对脓毒症患者预后产生较大影响（P＞0.05），PT、PCT、APTT、CRP、SOFA评分及APACHE Ⅱ评分对脓毒症预后产生严重影响，死亡组患者各指标水平均高于存活组（P＜0.05）；将影响脓毒症患者预后的单因素予以赋值，纳入Logistic回归分析，以PCT、PT、APTT、CRP、SOFA、APACHE Ⅱ 评分为自变量，结果显示，PCT、PT、CRP、SOFA、APACHE Ⅱ 评分是影响脓毒症患者预后的独立危险因素（P＜0.05）。结论：脓毒症患者发生凝血功能紊乱会对临床相关指标产生影响，从而增加疾病严重程度，依据脓毒症患者预后，研究结果显示，PT、PCT、CRP、SOFA及APACHE Ⅱ评分均会对脓毒症患者预后产生不良影响，检验上述指标水平，可为临床评估脓毒症预后提供一定参考价值。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the sepsis patients of blood coagulation dysfunction clinical characteristics and prognosis influencing factors. Methods: A total of 80 patients with sepsis admitted to our hospital from September 2019 to January 2023 were selected as the subjects of this study. Coagulation function tests were carried out on all patients. According to the test results, patients were divided into abnormal coagulation function group (n=60) and normal coagulation function group (n=20). Analysis of abnormal blood coagulation dysfunction and clinical features in patients with normal and abnormal blood coagulation dysfunction and disease severity in patients with normal, and on the basis of the prognosis of patients with sepsis, it can be divided into survival group (n=64) and death group (n=16) the prognosis of patients with sepsis of single factor and multi-factor Logistic regression analysis. Results: There were no significant differences in the mean arterial pressure, body temperature, white blood cell count (WBC), fibrinogen (FIB) and thrombin time (TT) indexes between normal and abnormal groups (P>0.05). The levels of respiration, pulse rate, procalcitonin (PCT), C-reactive protein (CRP), partial thromboplastin time (APTT), prothrombin time (PT) and PLT index were relatively high in patients with abnormal coagulation function group (P<0.05). Compared with sepsis patients with normal coagulation function, patients with abnormal coagulation function had higher incidence of acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and acute physiological function assessment (SOFA) scores, and longer ICU stay (P<0.05). Mechanical ventilation and hospital stay were compared (P>0.05); In the analysis of prognostic factors in patients with sepsis, the results showed that age, body mass index (BMI), gender, history of diabetes and history of hypertension did not have a great impact on the prognosis of patients with sepsis (P>0.05), while PT, PCT, APTT, CRP, SOFA score and APACHE Ⅱ score had a serious impact on the prognosis of patients with sepsis. All indexes in death group were higher than those in survival group (P<0.05). The single factors affecting the prognosis of patients with sepsis were assigned values and included in the Logistic regression analysis. With PCT, PT, APTT, CRP, SOFA and APACHE Ⅱ scores as independent variables, the results showed that PCT, PT, CRP, SOFA, APACHE Ⅱ score is the independent risk factors affecting the prognosis of patients with sepsis (P<0.05). Conclusion: The occurrence of coagulation disorders in patients with sepsis will affect the clinical related indicators, thus increasing the severity of the disease. According to the prognosis of patients with sepsis, the study results show that PT, PCT, CRP, SOFA and APACHE Ⅱ scores will have adverse effects on the prognosis of patients with sepsis. Can provide certain reference for clinical evaluation of prognosis of sepsis. |
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