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

doi:10.3877/cma.j.issn.1674-6902.2022.03.005

Abstract

Abstract:

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

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.

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References 30

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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

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

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

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

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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