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目的以凝血和血小板功能分析仪(SONOCLOT)研究脓毒症患者的凝血功能变化特点,为脓毒症早期干预和治疗提供理论依据。方法纳入脓毒症患者共56例,根据病情进展分为脓毒症组29例和脓毒性休克组27例,并选取同期健康体检者27例作为对照组。所有研究对象均测定凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、纤维蛋白原(FBG)、D-二聚体(D-Dimer)、抗凝血酶Ⅲ(AT-Ⅲ)活性、凝血Ⅶ因子活性、血小板(PLT)计数,同时以SONOCLOT检测其相关凝血指标:激活凝血时间(ACT)、纤维蛋白凝结速率(CR)、血小板功能(PF)。结果与对照组比较:脓毒症组、脓毒性休克组患者均有PT延长,FBG升高,D-Dimer升高,AT-Ⅲ活性及Ⅶ因子活性下降,差异均有统计学意义(P<0.05);脓毒症组ACT下降,CR延长,差异均有统计学意义(P<0.05),PF及PLT无明显差异(P>0.05);脓毒性休克组ACT延长,CR和PF及PLT均下降,差异均有统计学意义(P<0.05)。与脓毒症组相比:脓毒性休克组PT显著延长,FBG及D-Dimer明显升高,AT-Ⅲ活性及Ⅶ因子活性下降,PLT明显下降,ACT延长,CR和PF均下降,差异均有统计学意义(P<0.05)。3组间APTT值比较差异均无统计学意义(P>0.05)。结论脓毒症患者存在凝血功能紊乱,较传统凝血检查,SONOCLOT凝血监测能更早期、敏感和全面地识别脓毒症患者凝血功能异常。
Objective To investigate the changes of coagulation function in patients with sepsis by using coagulation and platelet function analyzer (SONOCLOT) to provide theoretical basis for early intervention and treatment of sepsis. Methods Fifty-six patients with sepsis were divided into sepsis group (n = 29) and septic shock group (n = 27) according to their progression. Twenty-seven healthy subjects were selected as control group. Thrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FBG), D-dimer, antithrombin III (AT-III) Activity, coagulation Ⅶ factor activity and platelet count (PLT). At the same time, the related coagulation parameters of activated coagulation time (ACT), fibrin clotting rate (CR) and platelet function (PF) were detected by SONOCLOT. Results Compared with the control group, all patients in sepsis group and septic shock group had prolonged PT, increased FBG, increased D-Dimer, decreased AT-Ⅲ activity and Ⅶ factor activity (all P < 0.05). There was a significant difference in ACT and CR between sepsis group and control group (P <0.05), no significant difference between PF and PLT group (P> 0.05) Decreased, the differences were statistically significant (P <0.05). Compared with the septic group, PT was significantly prolonged in septic shock group, FBG and D-Dimer significantly increased, AT-Ⅲ activity and factor activity decreased, PLT decreased significantly, ACT prolonged, CR and PF decreased, the difference was There was statistical significance (P <0.05). APTT values between the three groups showed no significant difference (P> 0.05). Conclusion There is coagulation disorder in sepsis patients. Compared with traditional coagulation tests, SONOCLOT coagulation monitoring can identify coagulation disorders in sepsis patients more sensitively and comprehensively.