临床医师对新型冠状病毒肺炎患者凝血相关事件认知的调查

doi:10.3877/cma.j.issn.2096-1537.2022.01.007

目的

评估疫情初期一线医师对新型冠状病毒肺炎（COVID-19）患者凝血相关事件的认知情况。

方法

通过网络调查问卷进行数据收集，分别对受访者一般情况、凝血系统的关注与评估，以及深静脉血栓（DVT）和急性肺栓塞（APE）的评估、诊断和治疗情况进行统计分析。

结果

在回收的70份调查问卷中，所有受访者均认为关注COVID-19患者的凝血系统改变是非常必要的，且大多数受访者认为危重型和重型患者应常规进行凝血指标的检测，分别为100.00%、92.86%。75.71%的受访者进行了弥散性血管内凝血（DIC）评分，其中大部分受访者倾向应用2017中国DIC评分标准（34.29%）。大多数受访者所收治的COVID-19患者DVT和APE发生率均＜5%，分别为84.29%、82.86%。分别有92.86%和82.86%的受访者进行了DVT的评估、筛查，大多数受访者更易选择机械联合药物的方式预防DVT（60.00%），应用最多的预防药物是低分子量肝素（54.29%）。

结论

临床医师已经注意到监测COVID-19患者的凝血系统变化是非常重要的，并且对于DVT和APE的评估与治疗相对规范。多数受访者所收治的患者DVT和APE的发生率很低，但大家对DIC诊断标准的选择差异很大。D-二聚体对于评估凝血系统改变是一项非常重要的指标，但纤溶过程在感染性疾病凝血功能障碍中的作用应重新审视。

关键词: 新型冠状病毒肺炎, 凝血相关事件, 弥散性血管内凝血

Objective

To assess the perceptions of the Chinese frontline senior clinicians regarding coagulation-related events in patients with coronavirus disease 19 (COVID-19).

Methods

This survey assessed the perceptions of the Chinese clinicians regarding the coagulation function in patients with COVID-19 and the evaluation, diagnosis, and treatment of deep vein thrombosis (DVT) and acute pulmonary embolism (APE).

Results

In 70 returned surveys, all respondents agreed that coagulation required attention. Most clinicians believed that COVID-19 patients should be routinely examined for coagulation indicators, with 100% and 92.86% of the doctors reporting a need to monitor patients in critical and severe conditions, respectively. Among the respondents, 75.71% believed the disseminated intravascular coagulation (DIC) score should be routinely measured, with 34.29% of whom preferring the 2017 Chinese DIC Scoring System (2017 CDSS). The DVT and APE incidence rates were＜5% among the patients treated by most of the doctors (84.29%, 82.86%, respectively). DVT assessment and screening were performed by 92.86% and 82.86% of the respondents respectively. Most respondents chose machinery and drugs for DVT prevention (60.00%), and low molecular-weight heparin for treatment(54.29%).

Conclusions

Most doctors believe that coagulation should be routinely monitored in COVID-19 patients, and assessment and treatment of DVT and APE should be standardized. Most respondents think the incidence of DVT and APE (＜5%) yet significant differences are noted in the clinicians' choice of DIC diagnostic criteria. The D-dimer level is a significant factor for assessing coagulation change in COVID-19 patients. However, the role of fibrinolytic processes in coagulation disorders with infectious diseases should be reconsidered.

Key words: COVID-19, Coagulation-related events, Disseminated intravascular coagulation

表1 受访者一般情况

一般情况	例数	百分比（%）
年龄（岁）
30~39	11	15.71
40~49	38	54.29
50~59	16	22.86
≥60	5	7.14
职称
高级	62	88.57
中级	8	11.43
医院等级
三级甲等	66	94.29
三级乙等	4	5.71
科室
ICU	62	88.57
急诊ICU	2	2.86
内科ICU	2	2.86
其他	4	5.71
工作经验（年）
6~10	2	2.86
11~15	13	18.57
16~20	14	20.00
＞20	41	58.57

表1 受访者一般情况

一般情况	例数	百分比（%）
年龄（岁）
30~39	11	15.71
40~49	38	54.29
50~59	16	22.86
≥60	5	7.14
职称
高级	62	88.57
中级	8	11.43
医院等级
三级甲等	66	94.29
三级乙等	4	5.71
科室
ICU	62	88.57
急诊ICU	2	2.86
内科ICU	2	2.86
其他	4	5.71
工作经验（年）
6~10	2	2.86
11~15	13	18.57
16~20	14	20.00
＞20	41	58.57

表2 受访者对COVID-19患者凝血指标和DIC诊断标准的选择情况

内容	例数	百分比（%）
需要常规监测凝血指标的人群（人次）
轻型	15	21.13
普通型	37	52.86
重型	65	92.86
危重型	70	100.00
凝血指标选择（人次）
D-D	69	98.57
PLT	57	81.43
Fib	52	74.29
PT/INR	41	58.57
APTT	39	55.71
FDP	38	54.29
APL	22	31.43
ATⅢ	21	30.00
Hb	13	18.57
Anti-factorⅩa	6	8.57
APC/APS	6	8.57
DIC标准选择
2017CDSS	24	34.29
JAAM	13	18.57
ISTH	13	18.57
SIC	3	4.29
临床经验	17	24.29

表2 受访者对COVID-19患者凝血指标和DIC诊断标准的选择情况

内容	例数	百分比（%）
需要常规监测凝血指标的人群（人次）
轻型	15	21.13
普通型	37	52.86
重型	65	92.86
危重型	70	100.00
凝血指标选择（人次）
D-D	69	98.57
PLT	57	81.43
Fib	52	74.29
PT/INR	41	58.57
APTT	39	55.71
FDP	38	54.29
APL	22	31.43
ATⅢ	21	30.00
Hb	13	18.57
Anti-factorⅩa	6	8.57
APC/APS	6	8.57
DIC标准选择
2017CDSS	24	34.29
JAAM	13	18.57
ISTH	13	18.57
SIC	3	4.29
临床经验	17	24.29

表3 受访者对COVID-19患者DVT、APE发生和治疗情况

内容	例数	百分比（%）
DVT发生率（%）
0	20	28.57
＜5	39	55.71
5~10	8	11.43
＞10	3	4.29
APE发生率（%）
0	27	38.57
＜5	31	44.29
5~10	9	12.86
＞10	3	4.29
DVT风险评估
是	65	92.86
否	5	7.14
DVT筛查
是	58	82.86
否	12	17.14
DVT预防选择
机械+药物	42	60.00
药物	22	31.43
机械	6	8.57
DVT治疗
LMWH	38	54.29
肝素	15	21.43
IVCF+LMWH	6	8.57
其他	11	15.71

表3 受访者对COVID-19患者DVT、APE发生和治疗情况

内容	例数	百分比（%）
DVT发生率（%）
0	20	28.57
＜5	39	55.71
5~10	8	11.43
＞10	3	4.29
APE发生率（%）
0	27	38.57
＜5	31	44.29
5~10	9	12.86
＞10	3	4.29
DVT风险评估
是	65	92.86
否	5	7.14
DVT筛查
是	58	82.86
否	12	17.14
DVT预防选择
机械+药物	42	60.00
药物	22	31.43
机械	6	8.57
DVT治疗
LMWH	38	54.29
肝素	15	21.43
IVCF+LMWH	6	8.57
其他	11	15.71

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Analysis of the Chinese clinicians' perceptions regarding coagulation-related events in patients with coronavirus disease

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Analysis of the Chinese clinicians' perceptions regarding coagulation-related events in patients with coronavirus disease