血栓弹力图及常规血凝检测与重症肺炎严重程度及预后的关系

发布时间：2018-06-25 11:50

本文选题：重症肺炎 + 凝血功能异常　；参考：《山东大学》2015年硕士论文

【摘要】：目的：血栓弹力图及常规血凝检测与重症肺炎严重程度及预后的关系方法：回顾性分析2013年12月到2014年12月在邹平县人民医院住院的重症肺炎患者(32例)。检测常规凝血四项(取PT、APTT、FIB三项)+血小板计数+D-二聚体,以及血栓弹力图(R时间、K时间、a角和MA值)各项指标,所有选入的患者均行“急性生理及慢性健康状况”(APACHE II)评分,按得分由低→高分为A、B、C三个观察组：A组,非危重组(得分小于12分)；B组,危重组(得分在12-25分之间)；C组,极危重组(得分大于25分)。根据患者预后的好坏,分为存活组、死亡组两组。比较各组间常规血凝各项指标(PT、APTT、 FIB、PLT、D-D)及血栓弹力图各主要指标的变化,对比分析血栓弹力图各主要指标与常规血凝各主要指标之间的相关性。结果：1.C组与A、B组比较,B组与A组相比较,PLT下降明显,D-D明显上升,PT明显延长,P值小于0.05,有统计学意义；APTT明显延长,P值小于0.001,有统计学意义。B组与A、C组比较,FIB略升高,P值大于0.05,无统计学意义。2.死亡组与存活组比较,PLT下降明显、D-D明显上升、APTT及PT均显著延长,P值小于0.05,有统计学意义,死亡组较存活组FIB稍增高,P值大于0.05,无统计学意义。3.C组与A、B组,B组与A组相对比,R值与K值增大较明显,MA值与α角度减小明显,P值小于0.05,有统计学意义。4.死亡组与存活组相对比,R值与K值减小明显,MA值与α角度增大明显,P值小于0.05,有统计学意义。5.R值与PLT呈负相关,r=-0.491,与DD呈正相关,r=0.600,P0.05；MA值与PLT及FIB呈正相关,r分别为0.801和0.795,与APTT、PT呈负相关,r分别为-0.555和-0.688,P0.05；α角度与PLT呈正相关,r=0.737,与PT、APTT呈负相关,r分别为-0.705和-0.700,P0.05； K值与PLT呈负相关, r=-0.730,与DD及PT呈正相关,r分别为0.516和0.607,P0.05。结论：重症肺炎患者多存在血凝学变化,其凝血功能紊乱程度同患者病情严重度及预后具有明显的相关性。血栓弹力图可以帮助判断患者凝血状态,其与常规血凝学检测指标具有明显相关性,两者对判断患者病情严重程度及预后均具有重要意义,可同时用于指导临床工作。
[Abstract]:Objective: to study the relationship between thromboelastography and routine hemagglutination test and the severity and prognosis of severe pneumonia. Methods: 32 cases of severe pneumonia hospitalized in Zouping County people's Hospital from December 2013 to December 2014 were retrospectively analyzed. The platelet count (D-dimer) and thromboelastography (R time K time angle and MA value) were measured in four items of routine coagulation (PTT APTTT FIB 3). All the selected patients were assessed with acute physiological and chronic health status (Apache II). According to the score, the three observation groups were: group A, group B, group B (score < 12), group C (score 12-25 points), group C (critical group) (score > 25). According to the prognosis of the patients, they were divided into two groups: survival group and death group. The changes of the main indexes of routine hemagglutination (PTT) and thromboelastogram were compared among groups, and the correlation between the main indexes of thromboelastography and the main indexes of routine hemagglutination was analyzed. Results 1. Compared with group A, the PLT of group B and group A was significantly decreased and the PT of group C was significantly longer than that of group A (P < 0.05), and there was significant difference between group B and group A (P < 0.05). APTT significantly prolonged P < 0.001. There was significant difference between group B and group A (P > 0.05), but there was no significant difference between group B and group A (P > 0.05). Compared with the survival group, the PLT decreased significantly in the death group and the D-D increased significantly. APTT and PT were significantly prolonged (P < 0.05), which had statistical significance. The FIB of death group was slightly higher than that of survival group (P > 0.05). There was no significant difference between group C and group A (P < 0.05), and the increase of R value and K value in group B and group A were more obvious than those in group A, and the decrease of MA value and angle of 伪 decreased significantly (P < 0.05), and there was significant difference between group C and group A (P < 0.05). Compared with the survival group, the R value and K value of the dead group decreased significantly. The increase of MA value and 伪 angle was significant (P < 0.05). There was a negative correlation between the value of 5.R and PLT, and a positive correlation with DD, 0.600 and 0.600, P 0.05. The positive correlation between MA and PLT and FIB was 0.801 and 0.795, the negative correlation between MA and APTTT was -0.555 and -0.688 (P0.05), the positive correlation between 伪 angle and PLT was 0.737, and the negative correlation between MA and PTT APTT was -0.705 and -0.700 P0.05, respectively. K value was negatively correlated with PLT (r = -0.730) and positively correlated with DD and PT (r = 0.516 and P = 0.607, P 0.05, respectively). Conclusion: hemagglutination changes often exist in patients with severe pneumonia, and the degree of coagulation dysfunction is significantly correlated with the severity and prognosis of severe pneumonia. Thromboelastography can help to judge the coagulation state of patients, and it has obvious correlation with the indexes of routine hemagglutination. Both of them have important significance in judging the severity and prognosis of patients' condition, and can be used to guide clinical work at the same time.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R563.1

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