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目的:探讨脓毒症患者中凝血异常的发生率和病情严重程度的关系。方法:分析了2009年3月-2009年8月在上海交通大学附属第一人民医院ICU和急诊病房住院符合脓毒症诊断标准的124例。分别在入院第1、7、14天测D-二聚体(D-dimer)、血小板计数、凝血全套。入院当天给以APACHEII评分、SOFA评分。根据D-dimer值分为3组,分别是D-dimmer<256μg/L、256≤D-dimer<1000μg/L、D-dimer≥1000μg/L。结果:所有入选病例第1、7、14天发生凝血异常的比例分别是38.7%、41.1%、45.9%。凝血异常组和无凝血异常组比较,D-dimer差异有统计学意义。随着D-dimer浓度增加,APACHEII和SOFA分值增加。结论:近半数脓毒症患者存在凝血功能障碍,其中D-dimer检测早期凝血功能障碍更为敏感。D-dimer与脓毒症的严重程度相关。
Objective: To investigate the relationship between the incidence of coagulation abnormalities and the severity of sepsis in patients with sepsis. Methods: From March 2009 to August 2009, 124 cases of sepsis admitted to ICU and emergency ward hospital of Shanghai First People ’s Hospital Affiliated to Shanghai Jiaotong University were analyzed. D-dimer, platelet count and whole blood coagulation were measured on the first, seventh and fourteenth days of admission respectively. Admission to the APACHEII score, SOFA score. According to the D-dimer value, they were divided into 3 groups: D-dimmer <256μg / L, 256≤D-dimer <1000μg / L and D-dimer≥1000μg / L. Results: The proportion of coagulation abnormalities on the 1st, 7th and 14th day in all the selected cases were 38.7%, 41.1% and 45.9% respectively. The difference of D-dimer in coagulation abnormal group and non coagulation abnormal group was statistically significant. As D-dimer concentrations increased, APACHEII and SOFA scores increased. Conclusion: Nearly half of patients with sepsis have coagulation disorders, of which D-dimer is more sensitive to early coagulation disorders. D-dimer is associated with the severity of sepsis.