心肺复苏患者凝血功能和血管性血友病因子动态变化及其与预后的关系

目的 探讨心肺复苏(CPR)不同预后患者凝血功能、血管性血友病因子(vWF)动态变化及意义.方法 选择50例心搏骤停后CPR患者,依复苏最终结果分为3组.复苏失败组25例,患者初期复苏成功、自主循环恢复(ROSC)≥72 h,但最终死亡;存活组10例,患者复苏成功,康复出院;死亡组15例, CPR 30 min后无效死亡,或虽复苏成功但ROSC<2 h.于CPR过程中及ROSC 24、48、72 h取血检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fg)、血小板计数(PLT)、D-二聚体、抗凝血酶Ⅲ(ATⅢ)、vWF水平的动态变化.结果 死亡组CPR过程中PT、APTT、TT、D-二聚体、vWF均高于复苏失败组和存活组,Fg、PLT、ATⅢ均低于复苏失败组和存活组(P均<0.01);而复苏失败组和存活组各指标比较差异均无统计学意义(P均>0.05).复苏失败组和存活组ROSC 24 h起PT、APTT、TT、D-二聚体、vWF水平升高,Fg、PLT、ATⅢ降低,均于ROSC 48 h达峰值或谷值(P<0.05或P<0.01);ROSC 72 h存活组各项指标较ROSC 48 h明显改善(P均<0.01),而复苏失败组则改善不明显(P均>0.05).复苏失败组ROSC 24、48、72 h PT、APTT、TT、D-二聚体、vWF水平显著高于存活组,Fg、PLT、ATⅢ显著低于存活组(P<0.05或P<0.01).结论 心搏骤停和随后CPR患者存在组织和血管内皮细胞损伤以及内/外源性凝血功能紊乱,纤溶功能紊乱;其变化对病情严重程度及预后有重要的判断价值.

Study on dynamic changes in coagulability and von Willebrand factor and its correlation with prognosis of cardiopulmonary resuscitation

Objective To investigate dynamic changes in coagulability and von Willebrand factor (vWF), and explore their correlation with prognosis of cardiopulmonary resuscitation (CPR). Methods Fifty CPR patients were divided into three groups according to the outcome. A group: 25 patients with successful recovery in the initial stage with restoration of spontaneous circulation (ROSC) lasting at least for 72 hours, but died ultimately; B group: 10 patients with successful recovery and finally survived; C group: the control group, 15 patients who died or ROSC<2 hours after CPR. In the course of CPR, dynamic changes in prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (Fg), platelet count (PLT), D-dimer, antithrombin Ⅲ (ATⅢ) and vWF were determined at the time of CPR, 24, 48 and 72 hours after ROSC. Results During CPR, the levels of PT, APTT, TT, D-dimer and vWF were higher, and the levels of Fg, PLT and ATⅢ were lower in group C compared with groups A and B (all P<0.01). There was no significant difference between groups A and B (all P>0.05). In groups A and B, the levels of PT, APTT, TT, D-dimer and vWF increased and the levels of Fg, PLT, ATⅢ decreased 24 hours after ROSC. The changes in all parameters reached peak or valley point at ROSC 48 hours (P<0.05 or P<0.01). At ROSC 72 hours all parameters were improved more obviously in group B (all P<0.01), but not improved in group A (all P>0.05). The levels of PT, APTT, TT, D-dimer and vWF were much higher and the levels of Fg, PLT and ATⅢ were much lower in group A than in group B (P<0.05 or P<0.01). Conclusion Tissue and vascular endothelial injury, endogenous and extrinsic coagulation disorder and fibrinolytic dysfunction are found in the patients undergoing CPR. Their dynamic changes are observed in the course of CPR, and they are valuable in assessing the severity of patients′ condition and prognosis.