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目的:探讨老年肺部感染致多器官功能衰竭(multiple organ failure,MOF)的血凝四项与D-二聚体的关系及其对弥散性血管内凝血(disseminated intravascular coagulation,DIC)发生的提示价值。方法:选取2014年1月至2015年12月62例老年肺部感染MOF患者,将其分为DIC组(21例)、DIC疑似组(20例)和非DIC组(21例),同时选择20例同期健康体检者为对照组。检测各组给予肝素钠及低分子肝素钙治疗前后的血凝四项与D-二聚体的水平,分析血凝四项与D-二聚体的关系,探讨上述关系对DIC发生的提示价值。结果:与对照组比,治疗前3组老年肺部感染MOF患者的D-二聚体、凝血酶时间(PT)和活化部分凝血活酶时间(APTT)明显增高(P<0.05),随着DIC程度加重,明显增高(P<0.05);血小板和纤维蛋白原(Fbg)明显降低(P<0.05),随着DIC程度加重,明显降低(P<0.05)。治疗后3组老年肺部感染MOF患者的D-二聚体、PT和APTT明显降低(P<0.05),血小板和Fbg明显增高(P<0.05),与治疗前比较有明显的差异(P<0.05)。D-二聚体与血小板(r=0.57)及Fbg(r=0.65)呈正相关(均P<0.05),D-二聚体与PT(r=-0.75)、APTT(r=-0.68)及TT(r=-0.72)呈负相关(均P<0.05)。治疗前后3组老年肺部感染MOF患者无一例死亡,治疗后非DIC组0例DIC,DIC疑似组2例DIC(10.0%)伴随D-二聚体偏高,DIC组5例DIC(23.8%)伴随D-二聚体偏高,所有发生DIC的患者凝血四项和血小板均正常。结论:血小板、D-二聚体、血凝四项的变化对老年肺部感染MOF患者的DIC发生及评估具有重要的临床参考价值;与血小板和凝血四项相比,D-二聚体的敏感性较高,对指导临床治疗及评估预后具有重要意义。
Objective: To investigate the relationship between four factors of hemagglutination and D-dimer in multiple organ failure (multiple organ failure) in elderly patients with lung infection and its implications for disseminated intravascular coagulation (DIC) value. Methods: Sixty-two elderly patients with MOF from January 2014 to December 2015 were selected and divided into DIC group (21 cases), DIC suspected group (20 cases) and non-DIC group (21 cases) 20 cases of healthy people as control group. The levels of hemagglutination and D-dimer before and after heparin sodium and low molecular weight heparin treatment were detected in each group, and the relationship between the four items of blood coagulation and D-dimer was analyzed to explore the value of the above-mentioned relationship in the occurrence of DIC . Results: Compared with the control group, the D-dimer, thrombin time (PT) and activated partial thromboplastin time (APTT) were significantly increased in the three groups before treatment (P <0.05) DIC increased significantly (P <0.05), while platelet and fibrinogen (Fbg) decreased significantly (P <0.05), with the degree of DIC increased significantly (P <0.05). After treatment, the D-dimer in three groups of aged patients with pulmonary infection of MOF were significantly lower (P <0.05), the platelets and Fbg were significantly higher (P <0.05), compared with those before treatment (P < 0.05). D-dimer was positively correlated with platelet (r = 0.57) and Fbg (r = 0.65) (P <0.05) TT (r = -0.72) (all P <0.05). There was no death in three groups of elderly patients with MOF before and after treatment. After treatment, DIC (10.0%) was higher in DIC than non-DIC group and DIC (10.0%) was accompanied by D-dimer in DIC group. DIC (23.8% ) With D-dimer high, all patients with DIC coagulation and platelets were normal. CONCLUSION: The changes of platelet, D-dimer and hemagglutination have important clinical value for the occurrence and evaluation of DIC in elderly patients with pulmonary infection of MOF. Compared with the four items of platelet and coagulation, D-dimer High sensitivity, to guide the clinical treatment and prognosis of great significance.