切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 ›› 2022, Vol. 08 ›› Issue (01): 49 -54. doi: 10.3877/cma.j.issn.2096-1537.2022.01.007

重症医学研究 上一篇    下一篇

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
王仲 1, 丁仁彧 1 , ( ), 马晓春 1   
  1. 1. 110001 沈阳,中国医科大学附属第一医院重症医学科
  • 收稿日期:2021-04-30 出版日期:2022-02-28
  • 通信作者: 丁仁彧
  • 基金资助:
    辽宁省教育厅科学研究经费项目(ZF2019010); 中国医科大学新冠肺炎防控相关研究项目

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

Zhong Wang 1, Renyu Ding 1 , ( ), Xiaochun Ma 1   

  1. 1. Department of ICU, the First Hospital of China Medical University, Shenyang 110001, China
  • Received:2021-04-30 Published:2022-02-28
  • Corresponding author: Renyu Ding
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。

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.

表1 受访者一般情况
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
表3 受访者对COVID-19患者DVT、APE发生和治疗情况
1
Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study [J]. Lancet, 2020, 395(10223): 507-513.
2
Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China [J]. JAMA Intern Med, 2020, 180(7): 934-943.
3
Wichmann D, Sperhake JP, Lütgehetmann M, et al. Autopsy findings and venous thromboembolism in patients with COVID-19 [J]. Ann Intern Med, 2020, 173(12): 1030.
4
Angus DC, van der Poll T. Severe sepsis and septic shock [J]. N Engl J Med, 2013, 369(9): 840-851.
5
Zhou Y, Fu B, Zheng X, et al. Pathogenic T cells and inflammatory monocytes incite inflammatory storm in severe COVID-19 patients [J]. Natl Sci Rev, 2020, 7(6): 998-1002.
6
Tanaka T, Narazaki M, Kishimoto T. Immunotherapeutic implications of IL-6 blockade for cytokine storm [J]. Immunotherapy, 2016, 8(8): 959-970.
7
Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19 [J]. Thromb Res, 2020, 191: 145-147.
8
Lodigiani C, Iapichino G, Carenzo L, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy [J]. Thromb Res, 2020, 191: 9-14.
9
Thrombosis and Hemostasis Group, Hematology Society of Chinese Medical Association. Consensus of Chinese experts on diagnosis of disseminated intravascular coagulation (version 2017) [J]. Zhonghua Xue Ye Xue Za Zhi, 2017, 38(5): 361-363.
10
Gando S, Iba T, Eguchi Y, et al. A multicenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: comparing current criteria [J]. Crit Care Med, 2006, 34(3): 625-631.
11
Taylor FB, Toh CH, Hoots WK, et al. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation [J]. Thromb Haemost, 2001, 86(5): 1327-1230.
12
Iba T, Nisio MD, Levy JH, et al. New criteria for sepsis-induced coagulopathy (SIC) following the revised sepsis definition: a retrospective analysis of a nationwide survey [J]. BMJ Open, 2017, 7(9): e017046.
13
China National Health Commission. Diagnosis and treatment of novel coronavirus pneumonia in China (trial version 7) [EB/OL]. [2020-3-3].

URL    
14
Liu Q, Wang RS, Qu GQ, et al. Gross examination report of a COVID-19 death autopsy [J]. Fa Yi Xue Za Zhi, 2020, 36(1): 21-23.
15
Jose RJ, Manuel A. COVID-19 cytokine storm: the interplay between inflammation and coagulation [J]. Lancet Respir Med, 2020, 8(6): e46-e47.
16
Xu Y, Zhu R, Sun Y, et al. Antithrombin Ⅲ for early diagnosis of DIC in sepsis patients: a retrospective analysis with 445 patients [J]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 2017, 29(2): 127-132.
17
Tang N, Li D, Wang X, et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia [J]. J Thromb Haemost, 2020, 18(4): 844-847.
18
Shorr AF, Thomas SJ, Alkins SA, et al. D-dimer correlates with proinflammatory cytokine levels and outcomes in critically ill patients [J]. Chest, 2002, 121(4): 1262-1268.
19
Owings JT, Gosselin RC, Anderson JT, et al. Practical utility of the D-dimer assay for excluding thromboembolism in severely injured trauma patients [J]. J Trauma, 2001, 51(3): 425-430.
20
Wang Z, Li X, Zhu R, et al. A reevaluation of diagnostic efficacy of International Society of Thrombosis and Haemostasis and Japanese Association for Acute Medicine criteria for the diagnosis of sepsis disseminated intravascular coagulation [J]. Zhonghua Nei Ke Za Zhi, 2019, 58(5): 355-360.
21
Semeraro F, Ammollo CT, Caironi P, et al. D-dimer corrected for thrombin and plasmin generation is a strong predictor of mortality in patients with sepsis [J]. Blood Transfus, 2020, 18(4): 304-311.
22
Zhang L, Yan X, Fan Q, et al. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19 [J]. J Thromb Haemost, 2020, 18(6): 1324-1329.
23
Gando S, Levi M, Toh CH. Disseminated intravascular coagulation [J]. Nat Rev Dis Primers, 2016, 2: 16037.
24
Valade S, Azoulay E, Galicier L, et al. Coagulation disorders and bleedings in critically ill patients with hemophagocytic lymphohistiocytosis [J]. Medicine (Baltimore), 2015, 94(40): e1692.
25
Gando S, Wada H, Thachil J. Differentiating disseminated intravascular coagulation (DIC) with the fibrinolytic phenotype from coagulopathy of trauma and acute coagulopathy of trauma-shock (COT/ACOTS) [J]. J Thromb Haemost, 2013, 11(5): 826-835.
26
Wada H, Matsumoto T, Yamashita R, et al. Disseminated intravascular coagulation: testing and diagnosis [J]. Clin Chim Acta, 2014, 436: 130-134.
27
Ding R, Wang Z, Lin Y, et al. Comparison of a new criteria for sepsis-induced coagulopathy and International Society on Thrombosis and Haemostasis disseminated intravascular coagulation score in critically ill patients with Sepsis 3.0: a retrospective study [J]. Blood Coagul Fibrinolysis, 2018, 29(6): 551-558.
28
Okamoto K, Tamura T, Sawatsubashi Y. Sepsis and disseminated intravascular coagulation [J]. J Intensive Care, 2016, 4: 23.
29
Zou Y, Guo H, Zhang Y, et al. Analysis of coagulation parameters in patients with COVID-19 in Shanghai, China [J]. Biosci Trends, 2020, 14(4): 285-289.
30
Helms J, Tacquard C, Severac F, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study [J]. Intensive Care Med, 2020, 46(6): 1089-1098.
31
Wada H, Nishioka J, Nobori T, et al. Diagnosis of DIC based on evidence [J]. Rinsho Byori, 2006, 54(11): 1172-1177.
32
Gando S, Saitoh D, Ogura H, et al. A multicenter, prospective validation study of the Japanese Association for Acute Medicine disseminated intravascular coagulation scoring system in patients with severe sepsis [J]. Crit Care, 2013, 17(3): R111.
33
Wada H, Matsumoto T, Yamashita Y. Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines [J]. J Intensive Care, 2014, 2(1): 15.
34
Iba T, Arakawa M, Nisio MD, et al. Newly proposed sepsis-induced coagulopathy precedes International Society on Thrombosis and Haemostasis overt-disseminated intravascular coagulation and predicts high mortality [J]. J Intensive Care Med, 2020, 35(7): 643-649.
35
Tang N, Bai H, Chen X, et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy [J]. J Thromb Haemost, 2020, 18(5): 1094-1099.
36
White RH. The epidemiology of venous thromboembolism [J]. Circulation, 2003, 107(23 Suppl 1): I4-8.
37
Raskob GE, Angchaisuksiri P, Blanco AN, et al. Thrombosis: a major contributor to global disease burden [J]. Arterioscler Thromb Vasc Biol, 2014, 34(11): 2363-2371.
38
Prichayudh S, Tumkosit M, Sriussadaporn S, et al. Incidence and associated factors of deep vein thrombosis in Thai surgical ICU patients without chemoprophylaxis: one year study [J]. J Med Assoc Thai, 2015, 98(5): 472-478.
39
Kaplan D, Casper TC, Elliott CG, et al. VTE incidence and risk factors in patients with severe sepsis and septic shock [J]. Chest, 2015, 148(5): 1224-1230.
40
Miri M, Goharani R, Sistanizad M. Deep vein thrombosis among intensive care unit patients; an epidemiologic study [J]. Emerg (Tehran), 2017, 5(1): e13.
41
Llitjos JF, Leclerc M, Chochois C, et al. High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients [J]. J Thromb Haemost, 2020, 18(7): 1743-1746.
42
Fogarty H, Townsend L, Cheallaigh CN, et al. More on COVID-19 coagulopathy in Caucasian patients [J]. Br J Haematol, 2020, 189(6): 1060-1061.
43
Zhang Y, Xiao M, Zhang S, et al. Coagulopathy and antiphospholipid antibodies in patients with Covid-19 [J]. N Engl J Med, 2020, 382(17): e38.
[1] 骆永芳, 周丹, 曾嘉慧, 田文硕, 朱白沙, 包明稳, 冯文霞, 张宇, 冯程. 床旁肺部超声评估新型冠状病毒肺炎患者肺损伤的价值[J]. 中华医学超声杂志(电子版), 2022, 19(01): 42-46.
[2] 张易薇, 朱双双, 谢雨霁, 孙薇, 朱业, 吴纯, 李玉曼, 谢明星, 张丽. 组织运动二尖瓣环位移对新型冠状病毒肺炎患者预后的预测价值[J]. 中华医学超声杂志(电子版), 2021, 18(12): 1153-1157.
[3] 程沙沙, 王玲, 古兰, 张月, 肖厚安, 邓旭东. 新型冠状病毒肺炎疫情期间围手术期不同术前访视和心理疏导的对比分析[J]. 中华损伤与修复杂志(电子版), 2021, 16(05): 432-434.
[4] 张丽君, 冯苹, 张玲, 邱文娟, 周万芳. 新型冠状病毒肺炎疫情期间援鄂医务人员不适现状调查及影响因素分析[J]. 中华损伤与修复杂志(电子版), 2021, 16(04): 326-332.
[5] 孟一星, 黄辉, 邓莉. 新型冠状病毒感染儿童皮肤损害[J]. 中华实验和临床感染病杂志(电子版), 2021, 15(06): 374-378.
[6] 陆明晰, 邓楚瑶, 刘玮丽. 肾移植受者感染新型冠状病毒并发急性排斥反应治疗成功一例[J]. 中华移植杂志(电子版), 2021, 15(04): 226-228.
[7] 钱丹, 何佳霖, 林昊, 黄其密, 刘唯佳, 赵国策, 刘玺, 高梦圆, 潘鑫涛, 任成山. 老年糖尿病患者并发新型冠状病毒肺炎预后及其相关因素分析[J]. 中华肺部疾病杂志(电子版), 2022, 15(01): 33-37.
[8] 鲁卫华, 王涛, 秦雪梅, 徐前程, 姜小敢. 早期清醒俯卧位联合经鼻高流量氧疗治疗重型新型冠状病毒肺炎一例[J]. 中华重症医学电子杂志, 2022, 08(01): 85-89.
[9] 顾延庆. 新型冠状病毒肺炎疫情防控背景下综合医院放射科应急管理策略浅谈:以北京市某二级医院为例[J]. 中华消化病与影像杂志(电子版), 2021, 11(04): 173-175.
[10] 李保坤, 冯鋆, 周超熙, 张建锋, 王晓然, 马洪庆, 王光林, 牛文博, 于滨, 王贵英. 局部新型冠状病毒肺炎疫情暴发后结直肠癌临床诊疗模式转换研究[J]. 中华临床医师杂志(电子版), 2021, 15(11): 819-823.
[11] 席金川, 牛文博, 王飞飞, 刘友强, 李保坤, 王贵英. 新型冠状病毒肺炎疫情后医务工作者创伤后应激障碍探讨[J]. 中华临床医师杂志(电子版), 2021, 15(11): 824-827.
[12] 顾明兰, 马庆华, 陆敏. 新型冠状病毒肺炎疫情下基层预防接种门诊的实践[J]. 中华临床医师杂志(电子版), 2021, 15(08): 637-640.
[13] 王光林, 刘广杰, 胡旭华, 王飞飞, 张建锋, 樊少青, 孟泽松, 李保坤, 张娟, 王贵英. 新型冠状病毒肺炎疫情下结直肠癌患者的管理策略[J]. 中华临床医师杂志(电子版), 2021, 15(06): 401-406.
[14] 王晒晒, 马庆华, 周国锋, 孙国辉, 陈忠文, 王波, 张天阳. 苏州市相城区社区疫情防治医务工作者的焦虑感和孤独感现况调查[J]. 中华临床医师杂志(电子版), 2021, 15(05): 382-387.
[15] 刘颖, 沈君华, 张云, 王芳. "新型冠状病毒肺炎"疫情下某三级综合医院急诊患者就诊特点与急诊管理思考[J]. 中华卫生应急电子杂志, 2021, 07(06): 342-345.
阅读次数
全文


摘要