急性呼吸窘迫综合征患者凝血纤溶系统变化的临床研究

目的检测急性呼吸窘迫综合征（ARDS）患者凝血功能的变化，并探讨其临床意义。方法ARDS患者43例，测定其血浆抗凝血酶（AT）、凝血酶原时间（PT）、活化部分凝血活酶时间（aPTT）、纤维蛋白原（Fbg）、D-二聚体和血小板计数（PLT）、血管性血友病因子（vWF），同时计算患者的急性生理和慢性健康评分（APACHEⅡ）和肺损伤评分（LIS）。23例健康体检者为正常对照。结果ARDS组患者血浆D-二聚体和vWF比对照组明显升高。ARDS组血浆AT水平明显低于对照组（P〈0．01）。ARDS组中死亡组D-二聚体和vWF水平明显高于存活组，AT水平明显低于存活组（P〈0．01）。AT与APACHEⅡ评分和LIS呈负相关，相关系数r分别为-0．812和-0．721；vwF与APACHEⅡ和LIS呈正相关，相关系数r分别为0．767和0．724。结论D-二聚体、vWF和AT在ARDS的发病过程中起重要作用，可用作临床医生判断患者预后及指导治疗的指标。

Clinical Research on Changes of Coagulation and Fibrinolysis Functions in the Patients with Acute Respiratory Distress Syndrome

Objective To observe the changes of coagulation and fibrinolysis functions in patients with acute respiratory distress syndrome （ARDS） and to discuss its clinical effect. Methods A total of 43 cases with ARDS were studied. The antithrombin （AT） , prothrombin time （PT） , activated partial thromboplastin time （aPTT） , fibrinogen （Fbg） , D- dimer , platelet count （ PLT）, yon Willebrand factor （vWF） , A-PACHE Ⅱscore and lung injury score（LIS） in patients with ARDS were measured. A total of 23 cases health volunteers were taken as the control. Results The plasma concentrations of vWF and D-dimer in patients with ARDS were significantly higher than those in control group （P 〈 0.01 ）, but the plasma concentrations of AT were significantly lower than those in control group o Compared with survival group, the plasma concentra- tions of vWF and D- dimer in died group were significantly increased while the AT level decreased （ P 〈 0.01 ）. The plasma concentrations of vWF were positive correlation with APACHE Ⅱscore and LIS （r = 0. 767 and 0. 724, respectively）. The plasma concentrations of AT were negative correlation with APACHE Ⅱ score and LIS （r=-0.812 and-0.721, respectively）. Conclusion The D-dimer, vWF and AT may play important roles in pathogenesis of ARDS, and be correlation with the degree of ARDS. It is suggested that they may be of importance in predicting the prognosis of patients with ARDS.