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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2022, Vol. 15 ›› Issue (03) : 311 -315. doi: 10.3877/cma.j.issn.1674-6902.2022.03.005

论著

NIPV治疗重症肺炎患者凝血功能及预后的影响因素分析
赵蒙蒙1, 杨俊俊1, 杨捷1, 曹柳兆1, 桑琳莉1,†()   
  1. 1. 225001　江苏，扬州大学临床医学院　江苏省苏北人民医院呼吸与危重症医学科
  • 收稿日期:2022-04-11 出版日期:2022-06-25
  • 通信作者: 桑琳莉
  • 基金资助:
    国家自然科学基金青年科学基金项目(81800049)

Analysis of influencing factors of coagulation function and prognosis of severe pneumonia patients undergoing non-invasive positive pressure ventilation

Mengmeng Zhao1, Junjun Yang1, Jie Yang1, Liuzhao Cao1, Linli Sang1,†()   

  1. 1. Respiratory Medicine Department, Northern Jiangsu People′s Hospital Affiliated to Yangzhou University, Yangzhou 225001, China
  • Received:2022-04-11 Published:2022-06-25
  • Corresponding author: Linli Sang
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引用本文：

赵蒙蒙, 杨俊俊, 杨捷, 曹柳兆, 桑琳莉. NIPV治疗重症肺炎患者凝血功能及预后的影响因素分析[J]. 中华肺部疾病杂志(电子版), 2022, 15(03): 311-315.

Mengmeng Zhao, Junjun Yang, Jie Yang, Liuzhao Cao, Linli Sang. Analysis of influencing factors of coagulation function and prognosis of severe pneumonia patients undergoing non-invasive positive pressure ventilation[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2022, 15(03): 311-315.

目的

分析行无创正压通气(noninvasive positive pressure ventilation, NIPV)治疗的重症肺炎(severe pneumonia, SP)患者凝血功能与预后的关系及影响因素。

方法

选择2017年1月至2021年12月因SP入住江苏省苏北人民医院重症监护病房并接受NIPV治疗的患者51例。根据患者凝血功能异常程度分为观察组24例，对照组27例，比较两组凝血功能及预后相关指标；分析影响预后的危险因素。

结果

观察组APTT、PT、INR、D-二聚体明显高于对照组；观察组患者气管插管比例明显高于对照组，且NIPV持续时间及ICU住院时间均明显长于对照组(P<0.05)。单因素分析结果提示，预后不良患者入院时APACHEⅡ评分、入院后48 h PT、APTT、INR、乳酸水平明显升高；患者入院时呼吸频率、心率、pH、PaCO2>60 mmHg比例以及NIPV开始时pH、PaO2、FiO2、PaO2/FiO2与患者的不良预后关系密切(P<0.05)。

结论

SP患者存在明显的凝血功能异常，且与预后密切相关；多种因素可影响行NIPV治疗的重症肺炎患者预后。重视并动态评估患者凝血功能可改善治疗预后。

关键词: 重症肺炎, 凝血功能, 无创正压通气治疗, 预后, 危险因素
Objective

To analyze the relationship between coagulation function and prognosis of severe pneumonia patients treated with noninvasive positive pressure ventilation (NIPV) and its influencing factors.

Methods

A total of 51 patients with severe pneumonia admitted to the intensive care unit of North Jiangsu People's Hospital from January 2017 to December 2021 and all patients were treated with NIPV. The patients were divided into observation group and control group according to the degree of abnormal coagulation function, and the indexes related to coagulation function and prognosis were detected and compared between these two groups. The respiratory rate, blood pressure, partial oxygen pressure, oxygenation index, lactic acid level and other related indicators of patients before and after non-invasive positive pressure ventilation were compared based on the prognosis of patients, and then the prognostic risk indicators were analyzed.

Result

24 of the 51 patients (47.06%) with severe pneumonia had obvious coagulation dysfunction at admission. APTT, PT, INR and D-dimer in the observation group were significantly higher than those in the control group. Compared with the control group, the proportion of tracheal intubation in the observation group was significantly higher than that in the control group, and the duration of NIPV and ICU stay were significantly longer than that in the control group (P<0.05). Univariate analysis indicated that APACHE-Ⅱ scores at admission and PT, APTT, INR and lactic acid levels at 48 hours after admission were significantly increased in the poor prognosis group. In addition, respiratory rate, heart rate, blood pH at admission, proportion of PaCO2>60 mmHg, blood pH, PaO2, FiO2, PaO2/FiO2 at the beginning of NIPV treatment were also closely related to poor prognosis, and the differences were statistically significant.

Conclusion

There are obvious abnormal coagulation dysfunction in patients with severe pneumonia, which is closely related to prognosis. Multiple factors can influence the outcome of patients with severe pneumonia treated with NIPV. In order to improve the prognosis of patients with severe pneumonia, it is necessary to pay attention to and dynamically evaluate the coagulation function of patients when NIPV treatment is performed.

Key words: Severe pneumonia, Coagulation function, Noninvasive positive pressure ventilation, Prognosis, Risk factors
表1 两组患者入院后48 h凝血功能比较(±s)
组　别 例数 APTT 凝血酶时间TT PT INR D-二聚体 纤维蛋白原 血小板
观察组 24 39.01±6.51 16.41±1.72 15.17±2.00 1.33±0.18 5.91±4.62 5.33±1.92 152.58±124.71
对照组 27 29.48±3.59 16.81±1.43 13.14±1.21 1.15±0.11 2.90±4.88 5.06±1.68 208.74±93.25
  t值   6.363 0.905 4.437 4.208 2.252 0.540 1.834
  P值   0.000 0.370 0.000 0.000 0.029 0.592 0.073
表2 两组患者预后比较
组　别 例数 气管插管[n(%)] NIPV持续时间(d) ICU住院时间(d) ICU死亡[n(%)]
观察组 24 13(54.17) 6.50±4.17 13.88±14.10 3(12.50)
对照组 27 7(25.93) 4.59±1.74 7.74±3.06 2(7.41)
  t/χ2   4.251 2.086 2.088 0.019
  P值   0.039 0.046 0.047 0.890
表3 NIPV治疗SP预后的单因素分析
临床资料 预后良好 预后不良 t/χ2值 P值
例数(男/女) 28(19/9) 23(13/10) 0.694 0.405
吸烟史[n (%)] 9(32.14) 7(30.43) 0.017 0.896
COPD[n(%)] 2(7.14) 1(4.35) 0.000 1.000
糖尿病[n (%)] 5(17.86) 4(17.39) 0.000 1.000
APACHEⅡ评分 11.71±7.10 16.57±5.74 2.644 0.011
入院时        
  呼吸频率(次/min) 25±5 29±6 2.550 0.014
  HR(次/min) 101±17 112±21 2.127 0.038
  pH 7.41±0.12 7.47±0.06 2.584 0.013
  PaO2 (mmHg) 56.28±18.98 53.96±11.40 0.539 0.593
  PaCO2>60 mmHg[n(%)] 4(14.29) 4(17.39) 1.000 0.000
NIPV后        
  pH 7.41±0.07 7.45±0.05 0.197 0.021
  压力支持水平 13.29±3.16 13.87±1.79 0.829 0.412
  PEEP水平 6.75±1.71 6.52±1.86 0.456 0.650
  PaO2 (mmHg) 89.64±27.88 75.35±17.81 2.126 0.039
  PaO2/FiO2 193.18±58.82 148.30±50.00 2.897 0.006
入院48 h        
  APTT 31.99±7.25 36.37±6.03 2.313 0.025
  TT 16.78±1.40 16.43±1.76 0.778 0.441
  PT 13.54±1.93 14.78±1.68 2.417 0.019
  INR 1.18±0.18 1.29±0.15 2.269 0.028
  D-二聚体 3.35±4.92 5.79±4.70 1.801 0.078
  FIB 5.15±1.84 5.23±1.76 0.166 0.869
  血小板 190.04±101.60 172.91±124.58 0.541 0.591
  乳酸 1.80±0.82 2.63±0.65 3.885 0.000
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