凝血功能紊乱与危重症患者病情及预后的相关性研究

目的：探讨危重症患者凝血功能的改变与病情严重程度和预后的关系。方法：将68例危重症患者按急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）评分分为A（〈12分）、B（12—25分）、C（〉25分）三组，D组为健康对照组，分析不同评分患者血浆凝血酶原时间（IT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）和血小板（PLT）的水平变化与APACHEⅡ的关系。并根据患者预后分为存活组和死亡组，比较两组上述指标的差异。结果：危重症患者AFFT、PT、TT明显长于D组，PLT和FIB明显低于D组，差异有统计学意义（P〈0．05）；死亡组与存活组相比，AFFT、PT、TT明显延长，PLT和FIB明显降低，差异有统计学意义（P〈0．05）；C组的IT、APTT、TT显著高于A组和B组，PLT和FIB显著低于A组和B组，差异有统计学意义（P〈0．05），B组的PT、APTT、TT显著高于A组，PLT和FIB显著低于A组，差异有统计学意义（P〈o．05），A组的PT高于D组，差异有统计学意义（P〈0．05），APTT略高于D组，但差异无统计学意义（P〉0．05），TT、PLT和FIB与D组比较差异无统计学意义（P〉0．05）。结论：危重症患者普遍存在凝血系统功能紊乱，PT、APTT、TT、FIB和PLT对患者的预后及病情轻重的判断具有重要价值。

Correlation study between coagulation disorders and severity and prognosis with critically ill patients

Objective： To explore the relationship between coagulation disorders and severity and prognosis with critically ill patients. Methods： 68 critically ill patients were divided into three groups based on acute physiology and chronic Health Evaluation（APACHE） Ⅱ, that were A group （APACHE seore〈12）, B group （APACHE score 12-25） and C group （A- PACHE score〉25）,group D （normal control group）. The prothrombin time （PT）,activated partial thromboplastin time （APTI）,thrombin time （tIT）,fibrinogen （FIB）,platelet （PLT） were measured, and the relationship between the coagulation markers and APACHE I1 score were studied by statistical analysis. Patients were divided into two groups according to sur- vival or death according to prognosis. Results： Compared with the normal control group, APTT, PT, Tr in patient group were significantly prolonged （all P〈0.05）, and PLT, FIB were significantly lower （all P〈0.05）. PT, APTT, TT in C group were significantly prolonged than A group and B group （all P〈0.05）, and PLT, FIB were significantly lower. PT, APTT, TT in B group were significantly prolonged than A group （all P〈0.05）, and PLT, FIB were significantly lower （all P〈0.05）. Compared with the normal control group, PT in A group was significantly prolonged （P〈0.05）,and APTT was slightly higher, but without significant difference between the two groups, while there was no significant difference in TT, PLT, FIB （P〉0.05）. APTT, PT, TT were significantly prolonged and PLT, FIB were significantly lower in nonsurvivor than those of survivor. Conclusion： The coagulation disorders with critically ill patients is universal existence, and the measurement of PT, APTT, TT, FIB, PLT can reflect critical patients ill condition and predict their prognosis.