Global tests of haemostasis in critically ill patients with severe sepsis syndrome compared to controls
Global tests of haemostasis in critically ill patients with severe sepsis syndrome compared to controls
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DOI：
10.1111/j.1365-2141.2006.06281.x
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发表时间：
2006-10-01
影响因子：
6.5
通讯作者：
Findlay, George P.
中科院分区：
文献类型：
--
作者：
Collins, Peter W.;Macchiavello, Luis I.;Findlay, George P.
脓毒症患者的止血变化是复杂的，既有促凝血变化，也有抗凝变化。对38例严重脓毒症患者和32例对照者进行凝血筛查、单因素分析、校准自动血栓描记术（CAT）、全血低剂量组织因子激活（LD-TFA）Rotem和LD-TFA波形分析。38例患者中有36例凝血筛查异常。与对照组相比，脓毒症组血浆因子II、V（P < 0.05）、VII、X、XI、XII、抗凝血酶和蛋白C（P < 0.01）水平明显降低。凝血因子VIII和纤维蛋白原水平升高（P < 0.001）。脓毒症患者富血小板血浆和贫血小板血浆中CAT的滞后时间延长（P < 0.02），凝血酶峰值降低（P < 0.02），凝血酶达峰时间延迟（P < 0.001），而内源性凝血酶潜力在脓毒症患者和对照组中相当。在LD-TFA Rotem中，脓毒症患者的凝血时间延迟（P = 0.04），但血栓形成的最大速度（P < 0.01）和血栓弹性曲线下面积（P < 0.01）增加。LD-TFA波形分析显示起效时间延迟，但血栓形成率增加（P < 0.005）。总之，全球止血试验表明，在该患者组中，止血激活延迟，但一旦开始凝血酶生成和血凝块形成正常或增强。
Haemostatic changes in septic patients are complex, with both procoagulant and anticoagulant changes. Thirty-eight patients with severe sepsis and 32 controls were investigated by coagulation screens, individual factor assays, calibrated automated thrombography (CAT), whole blood low-dose-tissue factor activated (LD-TFA) Rotem and LD-TFA waveform analysis. Thirty-six of 38 patients had an abnormal coagulation screen. The mean levels of factors II, V (P < 0.05), VII, X, XI and XII, antithrombin and protein C (P < 0.01) was decreased in sepsis compared with controls. The mean factor VIII and fibrinogen level (P < 0.001) was increased. CAT in platelet rich and poor plasma showed a prolonged lag time (P < 0.02), decreased peak thrombin (P < 0.02) and delayed time to peak thrombin (P < 0.001) in sepsis patients, however, the endogenous thrombin potential was equivalent in sepsis and controls. In LD-TFA Rotem, septic patients had delayed clot times (P = 0.04) but an increased maximum velocity of clot formation (P < 0.01) and area under the clot elasticity curve (P < 0.01). LD-TFA waveform analysis showed a delayed onset time but an increased rate of clot formation (P < 0.005). In conclusion, global tests of haemostasis suggest that in this patient group, activation of haemostasis is delayed but once initiated thrombin generation and clot formation are normal or enhanced.