Sonoclot监测ARDS患者凝血功能与PMA的表达的相关性研究

发布时间：2018-02-13 04:47

  本文关键词： 急性呼吸窘迫综合征 凝血功能 Sonoclot凝血功能监测 血小板-单核细胞聚集体　出处：《遵义医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究通过用Sonoclot凝血与血小板功能分析仪检测ACT、CR及PF,用流式细胞仪检测PMA的表达水平,探讨不同程度ARDS患者凝血功能的变化与PMA表达,并进行相关性分析,评估PMA能否作为ARDS凝血异常的风险预测因子,为干预ARDS患者凝血功能的变化提供新的思路及依据。方法:据2012 ARDS柏林定义,将ARDS患者分为轻度组32例,中度组28例,重度组27例,于入院24小时内采取外周用血用FCM检测PMA同时行Sonoclot凝血功能分析ACT、PF、CR,同步记录各组的APACHEⅡ评分,并随机选取24例无呼吸系统疾病的体检人员做为对照组,探讨不同程度ARDS患者凝血功能及PMA的表达水平。结果:87例ARDS与正常对照组相比较,PMA、APACHEⅡ评分、ACT水平明显升高,CR、PF明显降低,差异均有统计学意义(P0.01)。与正常对照组相比轻度组ACT、CR、PMA有变化但无显著性差异(P0.05),中度组和轻度组比较也有变化,但无显著性差异(P0.05),中度组和正常对照组有显著性差异(P0.01);重度组和正常对照组、轻度组、中度组比较差异均有统计学意义(P0.01)。外周血PMA与ACT(r=0.7726,P0.01)、APACHEⅡ评分与ACT(r=0.8188,P0.01)均呈正相关;PMA与CR(r=0.7117,P0.01)呈正相关;PMA与PF呈明显负相关(r=-0.7266,P0.01);APACHEⅡ评分与CR(r=0.7849,P0.01)呈正相关;APACHEⅡ评分与PF呈明显负相关(r=-0.7635,P0.01)。结论:ARDS患者凝血功能异常和病情发展有关,早期即有凝血功能的异常,凝血障碍随病情加重而加重;PMA与ACT、CR、PF均有良好相关性,但与ACT相关性最高,PMA随病情变化与APACHEⅡ评分正相关;PMA可作为判断ARDS凝血异常及病情严重程度的一项高危因子;ACT可作为监测ARDS凝血功能变化的可靠指标。
[Abstract]:Objective: to investigate the changes of coagulation function and PMA expression in patients with ARDS by using Sonoclot coagulation and platelet function analyzer and flow cytometry to detect the expression of PMA. To evaluate whether PMA can be used as a risk predictor for abnormal coagulation of ARDS, and to provide a new idea and basis for interfering with the change of coagulation function in ARDS patients. Methods: according to the Berlin definition of ARDS 2012, ARDS patients were divided into mild group (32 cases) and moderate group (28 cases). Within 24 hours after admission, 27 patients in severe group were treated with peripheral blood to detect PMA with FCM and Sonoclot coagulation function was analyzed simultaneously. The APACHE 鈪，

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