脓毒症及严重脓毒症患儿凝血功能变化的研究.doc
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脓毒症及严重脓毒症患儿凝血功能变化的研究
摘 要 目的:探讨脓毒症患者血D-二聚体水平及凝血功能数据变化的比较研究。方法:选择脓毒症及严重脓毒症患者各20例,观察两组患者治疗前、后及两组之间,凝血酶原时间(PT)、凝血酶原国际标准化比(PT-INR)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-dimer,D-D)数量变化。采用SPSS 13.0统计分析软件进行处理。结果:两组患者急性期除FIB无明显变化外,其余各项指标均明显延长。脓毒症组治疗前后凝血酶原时间,凝血酶国际标准化比值明显下降,有统计学意义(P<0.05),其他无显著变化;严重脓毒症组治疗前、后除纤维蛋白原外,其他数据明显下降,有统计学意义(P<0.05),而两组之间无统计学差异。结论:脓毒症存在凝血功能障碍,和病情严重程度有关。
关键词 脓毒症 凝血酶原时间 活化部分凝血活酶时间 D-二聚体 纤维蛋白原
AbstractObjective:to explore the changes of coagulation function in the patients with sepsis of postoperative.Methods:40 patients were divided into 2 groups:sepsis group and severe sepsis group according to the criteria for the selection of sepsis.the sepsis group included 20 patients and severe sepsis group included 20 patients.Results:levels of prothrobin time (pt),internation prothrobin time pt-INR thrombin time (tt),activated partial thomboplastin time (aptt),fibrinogen (fbg) and d-dimer (dd) were measured in all the patients.Result:levels of pt,tt,aptt and dd were higher in sepsis group and severe sepsis group but fibrinogen (fbg).levels of pt,apt,tt,and D-D in severe sepsis during acute stage were higer during Convalescence stage(P<0.05).in sepsis group,pt was prolonged,level of pt in sepsis was higer than in severe sepsis (P<0.05),but apt,tt,fbg and dd were not different between in sepsis and severe sepsis.Conclusions:there are dysfunctions of coagulation function in the patients with sepsis.the patientscoagulation function are associated with the prognosis and severity of sepsis.
Key wordssepsis;PT;APTT;DD;FBG
脓毒症(Sepsis)是严重创(烧)伤、休克、感染、外科大手术后常见的并发症[1],是由于感染而导致的全身性炎症反应综合征(systemic inflammation response syndrome,SIRS)的临床表现。如果脓毒症早期持续的SIRS得不到有效的控制,进一步发展可导致脓毒性休克、多器官功能障碍综合征(multiple organ dysfunction syndrome MODS),而MODS的进一步发展为多脏器功能衰竭(multiple organ failure,MOF),MOF是临床危重患者的最主要死亡原因之一;而凝血功能异常在脓毒症发生发展过程中具有重要作用[2]。脓毒症时机体炎症细胞过度激活,产生并释放大量细胞因子,这些过度释放的细胞因子通过各种途径激活凝血系统,使机体处于高凝状态,随即机体产生抗凝物质和启动纤维蛋白溶解系统。凝血系统活化,促进炎症进一步恶化,两者相互影响,共同促进脓毒症的恶化。因而监测脓毒症患儿的凝血
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