凝血功能紊乱对热射病患者日常生活能力评分的影响

Effect of coagulation disorders on score of Activity of Daily Living in patients with heat stroke

  • 摘要: 目的 探讨热射病患者凝血功能变化与入院后1周日常生活能力评分(ADL)变化的相关性。 方法 回顾性分析62例热射病患者初次检测(X)及发病后6~8 h首次复测(Xr)的凝血指标变化,观察各指标的峰值(Xp)、复测变化量(△X)及异常持续时间(DTx), 指标包括血小板计数(PLT)、凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)和D-二聚体(D-D)等,同时收集患者入院后1周ADL。按ADL的高低将患者分为ADL轻中度受损组(n=37)和ADL重度受损组(n=35), 采用Student-t检验比较2组患者凝血指标的变化。采用Pearson和Spearman相关分析评估ADL与凝血功能指标变化的相关性; 描绘相关凝血指标的受试者工作特征(ROC)曲线,以曲线下面积(AUC)评估其预测ADL受损的效能。 结果 2组PLT、PLTr、△PT、TT、TTr、DTTT、Fibr、DTD-D、PTLp、DTPTL、PT、PTr、PTp、DTPT、APTTp、Fib、△Fib、DTFib、D-D、D-Dr、D-Dp比较差异有统计学意义(P<0.05或P<0.01); ADL与PLT、PLTr、PLTp、Fib、Fibr、Fibp呈显著正相关(P<0.01), 与△PT、PT、PTr、PTp、TT、TTr、TTp、D-D、D-Dr、D-Dp、APTTp、△TT、△D-D及所有观察项目DTx呈显著负相关(P<0.01)。Fib预测出现ADL轻中度损伤的效能高于PLT, D-D对ADL重度受损的预测效能高于PT和TT。 结论 热射病生存者1周ADL与凝血功能的变化显著相关,凝血功能紊乱决定患者的神经功能预后, Fib、D-D对患者出现ADL受损的预测效能较高。

     

    Abstract: Objective To investigate the correlation between the change of coagulation function and change of score of Activity of Daily Living(ADL)at one week after hospital admission in patients with heat stroke. Methods The changes of coagulation indexes measured at the primary time(X)and 6 to 8 h after the onset of the disease(Xr)in 62 patients with heat stroke were analyzed retrospectively. The peak value(Xp), retest variation(△X)and abnormal duration(DTx)of each index were observed, including peripheral blood platelet count(PLT), prothrombin time(PT), thrombin time(TT), activated partial thromboplastin time(APTT), fibrinogen(Fib)and D-dimer(D-D), and ADL was also collected at one week after hospital admission. The patients were divided into mild and moderate ADL injury group(n=37)and severe ADL injury group(n=35)according to the level of ADL. Student-t test was used to compare the changes of coagulation indexes between the two groups. Pearson and Spearman correlation analysis were used to evaluate the correlation between ADL and coagulation function indexes. Receiver operating characteristic(ROC)curve of relevant coagulation - indexes was drawn, and the area under curve(AUC)was used to evaluate the efficacy in predicting ADL damage. Results There were significant differences in PLT, PLTr, △PT, TT, TTr, DTTT, Fibr, DTD-D, PTLp, DTPTL, PT, PTr, PTp, DTPT, APTTp, Fib, △Fib, DTFib, D-D, D-Dr and D-Dp between two groups(P<0.05 or P<0.01). ADL was positively correlated with PLT, PLTr, PLTp, Fib, Fibr and Fibp(P<0.01), and was negatively correlated with △PT, PT, PTr, PTp, TT, TTr, TTp, D-D, D-Dr, D-Dp, APTTp, △TT, △D-D and DTx of all the observation indexes(P<0.01). Fib was better than PLT in predicting mild or moderate injury of ADL, and D-D was more effective than PT and TT in predicting severe injury of ADL. Conclusion There is a significant correlation between ADL at one week after hospital admission and coagulation function in survivors with heat stroke. Coagulation disorders can determine the prognosis of neurological function, and Fib and D-D show higher predictive values for ADL impairment.

     

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