急性主动脉夹层凝血功能及预后因素分析

Q4 Nursing

中华急诊医学杂志 Pub Date : 2019-11-10 DOI:10.3760/CMA.J.ISSN.1671-0282.2019.11.014

Weibo Gao, L. Dou, Maojing Shi, Haiyan Zhang, Chun-bo Wu

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引用次数: 0

摘要

目的探讨急性主动脉夹层的临床特点、凝血功能及相关预后因素。方法对2008年11月至2016年1月北京大学人民医院收治的119例急性主动脉夹层患者的临床资料进行分析。所有参与者均经计算机断层扫描血管造影术证实，发病时间不到14天。收集第一次入院时的血常规检查、凝血功能数据，并记录手术干预和预后。根据预后或是否发生弥散性血管内凝血（DIC），将所有患者分为两组，并比较两组之间的差异。应用Logistic回归分析分析AAD患者住院死亡的独立危险因素。结果119例AAD患者的平均年龄为（52.9±14.2）岁，男女比例为5.3:1。疼痛是AAD患者最常见的临床表现，占90.0%以上。疼痛的性质主要是可扩展和/或传递性疼痛。显性DIC发生13例（10.9%），死亡7例（53.8%）。DIC组与非DIC组在中性粒细胞/淋巴细胞比率（NLR）、血小板计数、纤维蛋白原、D-二聚体、FDP、PT、APTT和死亡率方面有显著差异（P<0.05）。死亡组16例均为A型AAD，其中7例（43.8%）发生DIC。死亡组与存活组在NLR、血小板计数、纤维蛋白原、D-二聚体、FDP、PT、APTT、DIC比例及手术率等方面存在显著性差异（P<0.05）。Logistic回归分析表明，NLR和血小板计数是住院死亡的独立危险因素（P<0.05），结论D-二聚物对AAD具有较高的诊断和预后价值。死亡率随着血小板的活化和耗竭而增加。一旦发生DIC，预后极差。NLR和血小板计数是AAD患者住院死亡的独立危险因素。关键词：急性主动脉夹层；D-二聚体；中性粒细胞与淋巴细胞比率；弥散性血管内凝血；预后

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Analysis of coagulation function and prognostic factors of acute aortic dissection

Objective To investigate the clinical characteristics, coagulation function and associated prognostic factors of acute aortic dissection. Methods The clinical data of 119 patients with acute aortic dissection (AAD) admitted to Beijing University People's Hospital from November 2008 to January 2016 were analyzed. All the participants were confirmed by computed tomography angiography, and the onset time was less than 14 days. Data of blood routine test, coagulation function at the first admission were collected, and surgical intervention and prognosis were recorded. All the patients, according to the prognosis, or whether disseminated intravascular coagulation (DIC) occurred, were divided into two groups, and the differences between the two groups were compared. Logistic regression analysis was applied to analyze independent risk factors related to in-hospital death in AAD patients. Results In 119 patients with AAD, the average age was (52.9±14.2) years, with a male/female ratio of 5.3:1. Pain was the most common clinical manifestation in patients with AAD, accounting for more than 90.0%. The nature of pain was mostly expansible and/or transitive pain. Dominant DIC occurred in 13 cases (10.9%), and 7 patients died (53.8%). There were significant differences between the DIC group and non-DIC group in neutrophil/lymphocyte ratio (NLR), platelet count, fibrinogen, D-dimer, FDP, PT, APTT and mortality rate (P<0.05). All the 16 patients in the death group were type A AAD, among which, 7 patients (43.8%) developed with DIC. There were significant differences between the death group and survival group in NLR, platelet count, fibrinogen, D-dimer, FDP, PT, APTT, DIC proportion and surgical operation rate (P<0.05).Logistic regression analysis showed that NLR and platelet count were independent risk factors of in-hospital death (P<0.05). Conclusions D-dimer has a high diagnostic and prognosis value for AAD. The mortality increased with the activation and depletion of platelet. Once DIC occurs, the prognosis is extremely poor. NLR and platelet count are independent risk factors for in-hospital death in patients with AAD. Key words: Acute aortic dissection; D-dimer; Neutrophil to lymphocyte ratio; Disseminated intravascular coagulation; Prognosis

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来源期刊

中华急诊医学杂志 Nursing-Emergency Nursing

CiteScore

0.10

自引率

0.00%

发文量

8629

期刊介绍： Chinese Journal of Emergency Medicine is the only national journal which represents the development of emergency medicine in China. The journal is supervised by China Association of Science and Technology, sponsored by Chinese Medical Association, and co-sponsored by Zhejiang University. The journal publishes original research articles dealing with all aspects of clinical practice and research in emergency medicine. The columns include Pre-Hospital Rescue, Emergency Care, Trauma, Resuscitation, Poisoning, Disaster Medicine, Continuing Education, etc. It has a wide coverage in China, and builds up communication with Hong Kong, Macao, Taiwan and international emergency medicine circles.