失血性休克患者D-二聚体水平的变化及与弥漫性血管内凝血的关系

目的 探讨失血性休克患者D-二聚体水平的变化及与失血性休克后弥漫性血管内凝血(DIC)之间的关系.方法 将58例失血性休克患者分为并发DIC组(12例)和未并发DIC组(46例),另选取20例健康成人为正常对照组.正常对照组采外周静脉血4次,其余组分别于休克后1、3、5、7 d空腹采集外周静脉血,全自动乳胶微粒增强免疫比浊分析方法 测定血浆D-二聚体水平.结果 休克后1、3、5、7 d非DIC组D-二聚体(1108.42±229.69)、(948.85±216.32)、(836.96±193.82)、(728.92±183.85)μg/L]及DIC组(1254.49±289.65)、(1477.95±446.79)、(1665.81±652.36)、(1965.21±859.87)μg/L]均明显高于正常对照组(169.32±45.78)μg/L],差异有统计学意义(均P＜0.01),失血性休克后3、5、7 d非DIC组血浆D-二聚体水平持续降低(P＜0.01),而DIC组D-二聚体水平持续升高(P＜0.01);休克后3、7 d时DIC组D-二聚体水平与正常对照组及非DIC组比较差异均有统计学意义(P＜0.01).结论 休克后急性期D-二聚体的升高程度与休克后DIC的发生密切相关,测定失血性休克患者急性期外周血浆D-二聚体水平变化对预测休克后DIC的发生具有一定价值.

Changes of plasma D-dimer levels in hemorrhagic shock patients and the relation with disseminated intravascular coagulation

Objective To explore the relation between traumatic disseminated intravascular coagulation (DIC) with the levels of plasma D-Dimer(D-D) in hemorrhagic shock. Methods Totally 58 hemorrhagic shock patients were divided into DIC group( 12 cases) and non-DIC group(46 cases). Twenty healthy people were enrolled as the control group. Venous blood was collected only one time in the control group. But in other groups, venous blood was collected on 1,3, 5 and 7 day after shock. The D-D concentrations were measured by automated latex enhanced immunoassay. Results D-D level in the DIC group and non-DIC group were both higher than those in the control group. Furthermore, D-D level in the DIC group was remarkably higher than that in the non-DIC group. The plasma D-D of the DIC group were remarkably higher than that of the non-DIC group. Plasma D-D levels had significantly positive correlations during all time phases. Conclusions The D-D levels are not only relevant to the severity of shock but also closely to the occurrence of DIC after shock. The detection of plasma D-D levels can predict the occurence of DIC.