| 韦艳萍,胡军涛,黄雪敏,唐丽萍,廖 帅,黄勤英,陆虹合,韦 童,汤展宏.基于血栓弹力图指导下低分子肝素治疗脓毒症相关性凝血病的临床研究[J].,2024,(14):2794-2800 |
| 基于血栓弹力图指导下低分子肝素治疗脓毒症相关性凝血病的临床研究 |
| Clinical Study of Low Molecular Weight Heparin in the Treatment of Sepsis-Associated Coagulopathy Based on Thrombelastogram Guidance |
| 投稿时间：2024-01-21 修订日期：2024-02-17 |
| DOI：10.13241/j.cnki.pmb.2024.14.038 |
| 中文关键词: 脓毒血症 脓毒症相关性凝血病 血栓弹力图 低分子肝素 预测价值 |
| 英文关键词: Sepsis Sepsis-associated coagulopathy Thrombelastogram Low molecular weight heparin Predictive value |
| 基金项目:广西壮族自治区卫健委自筹经费科研课题（Z-A20220788） |
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| 中文摘要: |
| 摘要 目的：探讨血栓弹力图（TEG）指导低分子肝素治疗脓毒症相关性凝血病（SIC）的有效性和安全性，以及TEG与预后的关系。方法：选取2021年1月至2023年6月广西医科大学附属武鸣医院、广西医科大学第一附属医院及贺州广济医院收治的SIC患者185例。收集SIC患者的临床资料，根据是否抗凝分为抗凝组和未抗凝组。抗凝组根据TEG R值分为高凝组和正常凝血组。对比三组治疗后的临床指标。随访28 d，根据预后情况分为死亡组和存活组。比较死亡组和存活组临床指标、凝血指标。受试者工作特征（ROC）曲线分析脓毒症SIC患者28 d内死亡的预测价值。结果：高凝组及正常凝血组28 d内死亡率低于未抗凝组（P<0.05）。高凝组与正常凝血组弥散性血管内凝血（DIC）发病率低于未抗凝组（P<0.05）。存活组机械通气、血液净化、脓毒性休克、DIC、多脏器功能障碍综合征（MODS）比例低于死亡组（P<0.05）。存活组低分子肝素抗凝比例、低分子肝素抗凝时间高于死亡组（P<0.05）。死亡组的序贯器官衰竭评估（SOFA）评分、急性生理学与慢性健康状况（APACHE Ⅱ）评分高于存活组，重症监护室（ICU）住院时间长于存活组（P<0.05）。存活组与死亡组在K值、血栓最大振幅（MA）、综合凝血指数（CI）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶原时间-国际标准化比值（PT-INR）、纤维蛋白原（FIB）对比，差异有统计学意义（P<0.05）。ROC分析结果显示，K值、APACHE Ⅱ评分、SOFA评分预测SIC患者28 d死亡的曲线下面积（AUC）分别为0.653、0.727、0.730，联合检测预测的AUC为0.813，高于各指标单独检测。结论：基于TEG指导下可有助于识别SIC患者的凝血状态并指导临床抗凝治疗。同时TEG（K值）联合APACHE Ⅱ评分、SOFA评分对SIC患者28 d死亡具有较高的预测价值。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the efficacy and safety of thrombelastogram (TEG) guidance low molecular weight heparin in the treatment of sepsis-associated coagulopathy (SIC), and the relationship between TEG and prognosis. Methods: 185 SIC patients admitted to the Wuming Hospital Affiliated to Guangxi Medical University, The First Affiliated Hospital of Guangxi Medical University and Hezhou Guangji Hospital from January 2021 to June 2023 were selected. The clinical data of SIC patients were collected, and patients were divided into anticoagulant group and non-anticoagulant group according to whether they were anticoagulant. The anticoagulation group was divided into hypercoagulable group and normal coagulation group according to the R value of TEG. The clinical indexes in three groups after treatment were compared. After 28 days of follow-up, the patients were divided into death group and survival group according to the prognosis. The clinical indexes and coagulation indexes in death group and survival group were compared. The predictive value of death within 28 days in sepsis SIC patients was analyzed by receiver operating characteristic (ROC) curve. Results: The mortality rate within 28 days in hypercoagulable group and normal coagulation group was lower than that in non-anticoagulant group (P<0.05). The incidence of disseminated intravascular coagulation (DIC) in hypercoagulable group and normal coagulation group was lower than that in non-anticoagulation group (P<0.05). The proportion of mechanical ventilation, blood purification, septic shock, DIC and multiple organ dysfunction syndrome (MODS) in survival group was lower than that in death group (P<0.05). The proportion of low molecular weight heparin anticoagulation and the time of low molecular weight heparin anticoagulation in survival group were higher than those in death group (P<0.05). The sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluation (APACHE II) score in death group were higher than those in survival group, and the intensive care unit (ICU) hospitalization time was longer than that in survival group(P<0.05). The K value, maximum amplitude (MA), comprehensive coagulation index (CI), prothrombin time (PT), activated partial thromboplastin time (APTT), prothrombin time-international normalized ratio (PT-INR) and fibrinogen (FIB) were compared between survival group and death group, the difference was statistically significant(P<0.05). The results of ROC analysis showed that, the area under the curve (AUC) of K value, APACHE II score and SOFA score in predicting 28 d death of SIC patients was 0.653, 0.727 and 0.730 respectively, the AUC predicted by combined detection was 0.813, which was higher than that of each index alone. Conclusion: Base on TEG guidance can help to identify the coagulation status of SIC patients and guide the clinical anticoagulation therapy. And TEG (K value) combine with APACHE II score and SOFA score has a high predictive value for 28 d death in SIC patients. |
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