本文選題：重癥肺炎 + 凝血功能異常��； 參考：《山東大學(xué)》2015年碩士論文

【摘要】：目的：血栓彈力圖及常規(guī)血凝檢測與重癥肺炎嚴(yán)重程度及預(yù)后的關(guān)系方法：回顧性分析2013年12月到2014年12月在鄒平縣人民醫(yī)院住院的重癥肺炎患者(32例)。檢測常規(guī)凝血四項(取PT、APTT、FIB三項)+血小板計數(shù)+D-二聚體,以及血栓彈力圖(R時間、K時間、a角和MA值)各項指標(biāo),所有選入的患者均行“急性生理及慢性健康狀況”(APACHE II)評分,按得分由低→高分為A、B、C三個觀察組：A組,非危重組(得分小于12分)；B組,危重組(得分在12-25分之間)；C組,極危重組(得分大于25分)。根據(jù)患者預(yù)后的好壞,分為存活組、死亡組兩組。比較各組間常規(guī)血凝各項指標(biāo)(PT、APTT、 FIB、PLT、D-D)及血栓彈力圖各主要指標(biāo)的變化,對比分析血栓彈力圖各主要指標(biāo)與常規(guī)血凝各主要指標(biāo)之間的相關(guān)性。結(jié)果：1.C組與A、B組比較,B組與A組相比較,PLT下降明顯,D-D明顯上升,PT明顯延長,P值小于0.05,有統(tǒng)計學(xué)意義；APTT明顯延長,P值小于0.001,有統(tǒng)計學(xué)意義。B組與A、C組比較,FIB略升高,P值大于0.05,無統(tǒng)計學(xué)意義。2.死亡組與存活組比較,PLT下降明顯、D-D明顯上升、APTT及PT均顯著延長,P值小于0.05,有統(tǒng)計學(xué)意義,死亡組較存活組FIB稍增高,P值大于0.05,無統(tǒng)計學(xué)意義。3.C組與A、B組,B組與A組相對比,R值與K值增大較明顯,MA值與α角度減小明顯,P值小于0.05,有統(tǒng)計學(xué)意義。4.死亡組與存活組相對比,R值與K值減小明顯,MA值與α角度增大明顯,P值小于0.05,有統(tǒng)計學(xué)意義。5.R值與PLT呈負(fù)相關(guān),r=-0.491,與DD呈正相關(guān),r=0.600,P0.05；MA值與PLT及FIB呈正相關(guān),r分別為0.801和0.795,與APTT、PT呈負(fù)相關(guān),r分別為-0.555和-0.688,P0.05；α角度與PLT呈正相關(guān),r=0.737,與PT、APTT呈負(fù)相關(guān),r分別為-0.705和-0.700,P0.05； K值與PLT呈負(fù)相關(guān), r=-0.730,與DD及PT呈正相關(guān),r分別為0.516和0.607,P0.05。結(jié)論：重癥肺炎患者多存在血凝學(xué)變化,其凝血功能紊亂程度同患者病情嚴(yán)重度及預(yù)后具有明顯的相關(guān)性。血栓彈力圖可以幫助判斷患者凝血狀態(tài),其與常規(guī)血凝學(xué)檢測指標(biāo)具有明顯相關(guān)性,兩者對判斷患者病情嚴(yán)重程度及預(yù)后均具有重要意義,可同時用于指導(dǎo)臨床工作。
[Abstract]:Objective: to study the relationship between thromboelastography and routine hemagglutination test and the severity and prognosis of severe pneumonia. Methods: 32 cases of severe pneumonia hospitalized in Zouping County people's Hospital from December 2013 to December 2014 were retrospectively analyzed. The platelet count (D-dimer) and thromboelastography (R time K time angle and MA value) were measured in four items of routine coagulation (PTT APTTT FIB 3). All the selected patients were assessed with acute physiological and chronic health status (Apache II). According to the score, the three observation groups were: group A, group B, group B (score < 12), group C (score 12-25 points), group C (critical group) (score > 25). According to the prognosis of the patients, they were divided into two groups: survival group and death group. The changes of the main indexes of routine hemagglutination (PTT) and thromboelastogram were compared among groups, and the correlation between the main indexes of thromboelastography and the main indexes of routine hemagglutination was analyzed. Results 1. Compared with group A, the PLT of group B and group A was significantly decreased and the PT of group C was significantly longer than that of group A (P < 0.05), and there was significant difference between group B and group A (P < 0.05). APTT significantly prolonged P < 0.001. There was significant difference between group B and group A (P > 0.05), but there was no significant difference between group B and group A (P > 0.05). Compared with the survival group, the PLT decreased significantly in the death group and the D-D increased significantly. APTT and PT were significantly prolonged (P < 0.05), which had statistical significance. The FIB of death group was slightly higher than that of survival group (P > 0.05). There was no significant difference between group C and group A (P < 0.05), and the increase of R value and K value in group B and group A were more obvious than those in group A, and the decrease of MA value and angle of 偽 decreased significantly (P < 0.05), and there was significant difference between group C and group A (P < 0.05). Compared with the survival group, the R value and K value of the dead group decreased significantly. The increase of MA value and 偽 angle was significant (P < 0.05). There was a negative correlation between the value of 5.R and PLT, and a positive correlation with DD, 0.600 and 0.600, P 0.05. The positive correlation between MA and PLT and FIB was 0.801 and 0.795, the negative correlation between MA and APTTT was -0.555 and -0.688 (P0.05), the positive correlation between 偽 angle and PLT was 0.737, and the negative correlation between MA and PTT APTT was -0.705 and -0.700 P0.05, respectively. K value was negatively correlated with PLT (r = -0.730) and positively correlated with DD and PT (r = 0.516 and P = 0.607, P 0.05, respectively). Conclusion: hemagglutination changes often exist in patients with severe pneumonia, and the degree of coagulation dysfunction is significantly correlated with the severity and prognosis of severe pneumonia. Thromboelastography can help to judge the coagulation state of patients, and it has obvious correlation with the indexes of routine hemagglutination. Both of them have important significance in judging the severity and prognosis of patients' condition, and can be used to guide clinical work at the same time.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R563.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 陳渝寧,孫蕾,鄭錦輝,鄭威;腦出血患者預(yù)后與血脂血糖及凝血等指標(biāo)變化的相關(guān)性[J];中國臨床康復(fù);2004年22期

2 沈榮林;丁汀;樂園羅;;肺部感染患者血小板生成素測定的結(jié)果分析[J];浙江醫(yī)學(xué);2007年06期

，

本文編號：2065811