老年菌血症患者血小板及凝血功能的变化与意义

目的探讨重症监护室（ICU）老年菌血症患者血小板（PLT）及凝血功能的变化与临床意义。方法选择经实验室检测确认的 24例ICU老年菌血症患者为研究对象，比较其发生菌血症前后PLT及凝血功能的变化，以及不同病原体（革兰阳性球菌、革兰阴性杆菌和真菌）感染组、存活组与死亡组PLT及凝血功能的变化。结果发生菌血症后，老年患者PLT计数为（144.50±84.10）×109/L，部分活化的凝血酶原时间（APTT）为（47.04±14.60）s，凝血酶原时间（PT）为（18.63±8.92）s，纤维蛋白原（FIB）为（4.20±0.98）g/L，与基础值［分别为（233．18±78.20）×109/L、（33.98±7.36）s、（12.83±2.17）s、（3.16±0.79）g/L］比较，差异均有统计学意义（P＜0.05）；凝血酶时间（TT）无统计学差异（P＞0.05）。不同病原体感染组间PLT及相关凝血功能指标比较，差异无统计学意义（P＞0.05）。死亡组的PLT计数［（89.60±36.42）×109/L］低于存活组［（213.13±76.06）×109/L］，APTT值［（54.55±13.21）s］高于存活组［（35.93±7.03）s］（P＜0.05），FIB及PT无统计学差异（P＞0.05）。结论PLT及部分凝血功能指标可作为辅助诊断老年菌血症的参考之一，并可在一定程度上判断预后。

Changes and significance of platelet and blood coagulation function in elderly patients with bacteremia

ObjectiveTo evaluate the changes and clinical significance of platelet and blood coagulation function in elderly patients with bacteremia in an intensive care unit (ICU).MethodsTwenty four elderly patients with bacteremia were detected platelet count (PLT) and blood coagulation function before and after bacteremia occurred, PLT and blood coagulation function were compared among different pathogen infection groups (gram positive coccus, gram negative bacillus and fungus) and between survival and death group.ResultsAfter bacteremia occurred, PLT count was(144.50±84.10）×109/L, activated partial thromboplastin time(APTT) was (47.04±14.60)s，prothrombin time (PT) was (18.63±8.92)s, and fibrinogen (FIB) was （4.20±0.98）g/L, compared with baseline values (［233．18±78.20］×109/L, ［33.98±7.36］s, ［12.83±2.17］s, ［3.16±0.79］g/L,respectively),the differences were significant （P<0.05）,but thrombin time (TT) was not significant(P>0.05). PLT and blood coagulation function were not significantly different among different pathogen infection groups(P>0.05). PLT in death group was much lower than survival group(［89.60±36.42］×109/L vs ［213.13±76.06］×109/L)（P<0.05）, APTT was higher than survival group(［54.55±13.21］s vs［35.93±7.03］s)（P＜0.05）, both FIB and PT were not significantly different between death and survival group(P>0.05).ConclusionPlatelet and partial blood coagulation function indexes can be used as auxiliary diagnosis of bacteremia in elderly patients, and to some extent, it can judge prognosis.