【摘要】 目的调查北京地区重症监护病房(ICU)中弥漫性血管内凝血(DIC)的发病情况、原发病、病死率及其影响因素。方法采用2001年ISTH/SSC DIC专业委员会提出的DIC诊断标准,回顾性调查1998年5月～2003年4月北京地区8所三级综合医院ICU中收治DIC患者。结果DIC患者87例,占同期ICU收治危重病人的1·03%;其中感染性疾病(39·1%)、创伤(20·7%)、大手术(11·5%)、重症胰腺炎(10·9%)是最常见原发病。DIC总病死率为63·2%,对病死率分别以年龄、性别、APACHE-Ⅱ评分进行调整,调整后5年间的病死率均无显著性差异(P>0·05)。单纯DIC患者死亡率为0,DIC患者累及器官越多,死亡率越高。结论DIC是北京地区ICU中常见危重症,病死率很高,且近年来并未下降,应给予重视。更多还原

【Abstract】 Objective The purpose of present study was to describe the incidence,causes and outcome of disseminated intravascular coagulation(DIC) in intensive care units(ICU) of Beijing hospitals.Methods Multi-center retrospective cohort study was performed on DIC patients from eight hospitals of the third class in Beijing from May,1998 to April,2003.Data were collected of general items,acute physiology and chronic health evaluation(APACHE) Ⅱ score,chemical examination,prognosis and the cause of death,and so on.DIC was diagnosed according to the criteria issued in 2001 by International Society of Thrombosis and Haemostasis(ISTH).Results Of 8482 patients admitted to ICUs,DIC occurred in 87 patients(1.03%).Infection disease(39.1%),trauma(20.7%),major operation(11.5%) and acute severe pancreatitis(10.9%) composed the majority of primary diseases suffered by DIC patients.The overall mortality of DIC was 63.2%,the mortality adjusted on age,gender and APACHEⅡ score,respectively,showed no significant changes during 5 years(P>0.05).No significant difference on mortality was found between infection disease and non-infection disease.The mortality of patients with platelet count less than or equal to 50×109/L was higher than those with platelet count greater than 50×109/L(P<0.05).The mortality of DIC patients with other dysfunction of 1-4 organs was 18.2%-94.1% correspondingly,and the mortality of DIC patients complicated with the dysfunction of kidney,lung,cardiovascular system,liver,brain and digestive tract were 71.3%,70%,62.1%,51.7%,44.8% and 43.7%,respectively.Conclusions DIC was occurred frequently in ICUs of Beijing hospitals,the mortality was still high,and wasn’t decline in recent years,so attention should be taken seriously.更多还原