目的 探讨急性有机磷中毒患者凝血功能的变化及预后评估.方法 选取62例急性有机磷中毒患者,根据国家急性有机磷农药中毒诊断及分级诊断标准分为轻度组(17例)和中重度组(45例),根据其预后分为存活组(39例)和死亡组(23例),以30例健康体检者作为对照组.所有患者均进行血栓弹力图(TEG)及凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D)、纤维蛋白(原)降解产物(FDP)常规凝血指标检测,并对预后凝血功能进行评估.结果 中重度组与对照组、轻度组比较,PT、APTT、TT明显延长(P＜0.05),D-D、FDP水平明显升高(P＜0.05),FIB水平差异无统计学意义(P＞0.05).死亡组PT、APTT、TT较存活组明显延长(P＜0.05),FIB水平明显降低(P＜0.05),D-D、FDP水平明显升高(P＜0.05).随着急性有机磷中毒患者中毒程度增加,中重度组患者K值、R值明显增加(P＜0.05),Angle角、MA值、CI值明显减小(P＜0.05).与存活组比较,死亡组K值、R值明显升高(P＜0.05),Angle角、MA值、CI值明显降低(P＜0.05).TEG检测中R值分别与PT、APTT呈正相关(r=0.623、0.495,P=0.014、0.031);K值与PT、APTT呈正相关(r=0.493、0.641,P=0.038、0.011),与FIB呈负相关(r=-0.435,P=0.039);Angle角分别与PT、APTT、D-D呈负相关(r=-0.549、-0.561、-0.443,P=0.028、0.025、0.035),与FIB呈正相关(r=0.572,P=0.017);MA值与FIB呈正相关(r=0.613,P=0.020);CI值与APTT呈负相关(r=-0.416,P=0.041),与FIB呈正相关(r=0.473,P=0.032).结论 急性有机磷中毒患者随着中毒程度加重,凝血功能出现低凝状态,有出血倾向.且TEG检测指标与常规凝血指标存在一定的相关性,通过TEG检测,有利于监测不同中毒程度的急性有机磷中毒患者的凝血功能状态,指导临床对早期出现凝血功能紊乱的患者进行及时干预.%Objective To investigate the coagulation function in patients with acute organophosphorus poisoning and to evaluate the prognosis.Methods Sixty-two patients with acute organophosphate poisoning were selected. According to the national diagnostic criteria of acute organophosphate poisoning and diagnostic criteria, they were divided into mild group (17 cases) and medium restructuring group (45 cases). According to the prognosis, they were divided into survival group (39 cases) and death group (23 cases). TEG testing and prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), D-dimer (D-D), fibrin The (original) degradation product (FDP) were tested for routine coagulation parameters and the prognostic coagulation function was assessed on all patients. Results Compared with the control group and the mild group, the PT, APTT, and TT were significantly prolonged (P＜0.05), and the D-D and FDP levels were significantly increased (P＜0.05). There was no significant difference in FIB between the reconstituted and control groups (P＞0.05). PT, APTT, and TT in the death group were significantly longer than those in the survival group (P＜0.05). FIB level was significantly lower (P＜0.05), and D-D and FDP levels were significantly higher in the death group were significantly longer than those in the survival group (P＜0.05). With the increase in the degree of poisoning in patients with acute organophosphate poisoning, the K value and R value of the patients were significantly increased (P＜0.05), and the angles of Angle, MA, and CI were significantly reduced (P＜0.05). Compared with the survival group, the K and R values in the death group were significantly higher (P＜0.05), and Angle, MA, and CI values were significantly reduced (P＜0.05). The R value of TEG was positively correlated with PT and APTT (r=0.623 an 0.495, P=0.014 and 0.031). The K value was significantly positively correlated with PT and APTT (r=-0.493, 0.641, P=0.038, 0.011). There was a significantly negative correlation between K value and FIB (r=-0.435, P=0.039). Angle was significantly negatively correlated with PT, APTT an D-D (r=-0.549, -0.561 and-0.443, P=0.028, 0.025 and 0.035), and postively correlated with FIB (r=0.572, P=0.017). MA was significantly positively correlated with FIB (r=0.613, P=0.020). CI was significantly negatively correlated with APTT (r=-0.416, P=0.041), positively correlated with FIB (r=0.473, P=0.032). Conclusion With the increase of the degree of poisoning in patients with acute organophosphate poisoning, the coagulation function shows a hypocoagulated status with bleeding tendency. The TEG detection index has a certain correlation with the conventional coagulation index. Through the TEG test, it is helpful to monitor the coagulation state of patients with acute organophosphate poisoning, and guide the clinical intervention of patients with early coagulation dysfunction.
展开▼
