2018 年第 12 期 第 13 卷

血栓弹力图最大血块强度值和免疫指标对脓毒症患者预后的评估价值

Prognostic values of maximum amplitude in thrombelastogram and immune indexes for sepsis

作者：梁继芳王秀哲武卫东杨晓静武文静姜美妮

英文作者：

单位：030032太原，山西大医院重症医学科

英文单位：

关键词：脓毒症；最大血块强度值；补体C3；生存分析

英文关键词：

• 摘要：

• 【摘要】目的    探讨血栓弹力图最大血块强度（MA）值和免疫指标对脓毒症患者预后的评估价值。方法    选择2016年7月至2018年4月在山西大医院明确诊断为脓毒症患者127例，根据患者入住重症监护病房（ICU）第1天血栓弹力图MA值测量结果分为MA值降低组（MA值＜50 mm，49例）及MA值正常或升高组(MA值为50~70 mm及MA值＞70 mm，78例)，比较2组患者疾病严重程度评估指标、28 d病死率、免疫学指标、住院治疗过程中相关指标和并发症发生率的差异，并对2组患者的累积生存率进行比较。结果    MA值降低组急性生理学与慢性健康状况评分系统Ⅱ评分及序贯器官衰竭评分均明显高于MA值正常或升高组［（23±6）分比（13±5）分， 9（4,11）分比7（5,8）分］（均P＜0.05）。MA值降低组补体C3水平高于MA值正常或升高组［(0.81±0.21)g/L比（0.62±0.23）g/L］（P＜0.001）。MA值降低组在ICU治疗期间的日均费用高于MA值正常或升高组，呼吸机使用时间、血管活性药物使用时间均长于MA值正常或升高组，治疗期间应用连续肾脏替代疗法率、输血率、血培养阳性率、脓毒症休克和多器官功能障碍综合征发生率均高于MA值正常或升高组（均P＜0.05）。MA值降低组与MA值正常或升高组生存率比较差异无统计学意义（P=0.098）。根据MA值和补体C3值是否降低进一步分为4组，MA值、补体C3均降低组29例，死亡10例；MA值降低、补体C3未降低组20例，死亡1例；MA值正常或升高、补体C3降低组31例，死亡3例；MA值正常或升高、补体C3未降低组47例，死亡4例。MA值、补体C3均降低组生存率均低于其他3组（均P＜0.05）。结论    脓毒症患者存在MA值的下降，且与疾病严重程度有关，MA值降低者需要更多的器官功能支持治疗，动态监测MA值联合补体C3的变化对脓毒症患者的预后判断有更好的指导意义。

• 【Abstract】Objective    To explore the prognostic values of maximal amplitude(MA) in thrombelastogram and immune indexes in patients with sepsis. Methods    Totally 127 patients were diagnosed of sepsis in Shanxi Dayi Hospital between July 2016 and April 2018. According to measuring Results of MA on admission to intensive care unit(ICU), they were divided into decreased MA group（MA＜50 mm， n=49） and normal/increased MA group(MA 50-70 mm or＞70 mm， n=78). Disease severity indicators, 28 d mortality, immune indexes, therapeutic indicators, complications and cumulative survival rate were analyzed. Results    The decreased MA group had higher APACHEⅡ and SOFA scores［（23±6） vs （13±5）, 9（4,11） vs 7（5,8）］（P＜0.05）, higher complement C3 level［(0.81±0.21)g/L vs （0.62±0.23）g/L］（P＜0.001）, higher daily costs in ICU, longer mechanical ventilation time and vasopressor agents use time, higher transfusion and continuous renal replacement therapy rates, higher blood culture positive rate, higher incidences of sepsis shock and multiple organ dysfunction syndrome compared to those in the normal/increased MA group（all P＜0.05）. There was no significance difference of survival rate between groups（P=0.098）. The patients were divided into 4 groups according to both MA and complement C3: decreased MA and complement C3 group(n＝29, with 10 deaths); decreased MA and non-decreased C3 group(n＝20, with 1 death); normal/increased MA and decreased C3 group(n＝31, with 3 deaths); normal/increased MA and non-decreased C3 group(n＝47, with 4 deaths). Survival rate in the decreased MA and C3 group was significantly lower than that in other three groups（P＜0.05）. Conclusions    Sepsis patients may have low MA value, which is associated with the severity of disease. Patients with low MA need organ function support therapy. Combined detection of MA and complement C3 has a good prognostic value for sepsis.