目的：探讨连续性血液净化（ CBP）治疗心肺复苏术（ CPR）后凝血功能障碍的临床疗效。方法选取2010年10月—2013年5月承德市中心医院经急诊院前、院内行CPR的心搏骤停患者56例，采用随机数字表法分为对照组20例和治疗组36例。对照组采用常规治疗，治疗组入重症监护室（ ICU）后予以CBP联合常规治疗，记录两组患者治疗前（T1）及治疗后24 h（T2）、48 h（T3）及72 h（T4）凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（Fg）水平及72 h 存活率、多器官功能障碍综合征（MODS）发生率。结果对照组和治疗组不同时间PT、APTT、TT、Fg水平比较，差异均有统计学意义（ P＜0.05）；T1时治疗组与对照组PT、APTT、TT、Fg水平比较，差异均无统计学意义（ P＞0.05）；T2、T3、T4时治疗组与对照组PT、APTT、TT比较，差异均有统计学意义（P＜0.05）；T4时治疗组Fg水平较对照组升高（P＜0.05）；治疗组PT、APTT和TT在T2、T3、T4时较T1时降低，T3、T4时较T2时降低，T4时较T3时降低（P＜0.05）；治疗组Fg水平T3、T4时较T1时升高，T4时较T2、T3时升高（P ＜0.05）。治疗组患者72 h 后存活率高于对照组，MODS 发生率低于对照组（P ＜0.05）。结论早期应用CBP可使CPR后凝血功能障碍患者短期内临床获益，CBP是治疗CPR后凝血功能障碍、防治MODS和改善预后的一种有效手段。%Objective To explore the clinical effect of continuous blood purification( CBP)on coagulation disorders after cardiopulmonary resuscitation(CPR). Methods 56 patients with coagulation disorders after CPR who were admitted to the Department of Emergency of Chengde Central Hospital from October 2010 to May 2013 were randomly divided into control group(n=20)and treatment group(n =36). The control group was treated with conventional therapy,and the treatment group was treated with CBP after admission of ICU. The prothrombin time( PT),activated partial thromboplastin time( APTT), thrombin time(TT),fibrinogen(Fg)levels before treatment(T1),24 h(T2),48 h(T3)and 72 h(T4)after treatment were recorded, and the 72 h survival rate and incidence of multiple organ dysfunction syndrome ( MODS ) were also recorded. Results There were statistical difference in PT,APTT,TT,level of Fg between control group and treatment group at different time points(P<0. 05). At T1,the PT,APTT,TT and Fg level between control group and treatment group showed no statistically significant differences(P >0. 05);at T2,T3 and T4,the PT,APTT and TT between control group and treatment group all showed statistically significant differences(P<0. 05);at T4,Fg levels between control group and treatment group showed statistically significant differences(P<0. 05);in the treatment group,compared with T1,the PT,APTT and TT at T2,T3 and T4 were significantly lower,and compared with T2,the PT,APTT and TT at T3 and T4 were significantly lower,and compared with T3,those at T4 were also significantly lower(P<0. 05);compared with T1,the Fg levels at T3 and T4 were significantly higher,and compared with T2 and T3,those at T4 were significantly higher(P<0. 05). The 72 h survival rate of the treatment group was significantly higher than that of the control group,and incidence of MODS of the treatment group was significantly lower than that of the control group(P<0. 05). Conclusion Patients with coagulation disorders after CPR can benefit from the early application of CBP in the short term,and CBP is an effective method in treating coagulation disorders after CPR,preventing MODS and improving prognosis.
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