Objective: To investigate the clinical characteristic of coagulation, possible causes and countermeasures of patients with severe corona virus disease 2019 (COVID-19).
Methods: The clinical data of the 142 patients diagnosed as COVID-19 at Wuhan Third Hospital in Wuhan, China, from February 10 to February 16, 2020 were collected and analyzed retrospective. Among the patients, 17 cases of dead patients were divided into observe group, and 125 cases of cured patients were divided into control group. The clinical characteristics, laboratory tests, influencing factors, anticoagulant therapy, embolization and bleeding events of the two groups were observed.
Results: The average hospital stay time in 142 patients was 22 d. For the 17 dead patients in the observe group, the average hospital stay time was 9.9 d, and the D-dimer, prothrombin time, WBC count and Padua score of the patients in the observe group were significantly higher as compared with the patients in the control group. PT(OR=1.064, 95%CI 1.012-1.119) and D-D(OR=1.045, 95%CI 1.027-1.064) were the independent risk factors that causing the death of COVID-19 patients. Among the patients, 36(25.4%) patients received low-molecular-weight heparin for anticoagulant therapy, with the average course of 9.6 d. The cumulative incidence of the embolism of the patients in the observe group was 7（41.2%）, while 2(11.8%) patients developed to deep vein thrombosis (DVT) and pulmonary embolism (PE), 3 (17.6%) patients occurred acute cerebral infarction and 2 (11.8%) patients occurred acute myocardial infarction. 3 (17.6%) dead patients revealed dominant disseminated intravascular coagulation (DIC).
Conclusion: Most patients with severe COVID-19 shows a variety of risk factors for thrombus, and those with coagulation dysfunction shows a high dead rate and rapid disease progression. Therefore, coagulation indicators should be dynamically monitored, and mechanical and drug prevention should be actively carried out.
题目: 新型冠状病毒肺炎重症患者凝血功能的特征和影响因素分析.
目的: 分析新型冠状病毒肺炎（COVID-19）重症患者凝血功能的临床特点，并探讨凝血功能异常的可能原因与应对措施.
方法: 收集并回顾性分析2020年2月10日至2020年2月16日武汉市第三医院收治的COVID-19重症患者142例的临床资料，17例死亡患者设为观察组，125例治愈出院患者为对照组。观察2组患者的临床特点，实验室指标和影响因素，抗凝治疗现状，栓塞和出血事件.
结果: 142例患者平均住院时间为22 d。观察组患者平均住院时间为9.9 d，均较对照组患者有更高的D-二聚体(D-D)、凝血酶原时间(PT)、活化部分凝血酶原时间（APTT）、白细胞计数（WBC）、中性粒细胞百分比（NEU%）和Padua评分。PT(OR=1.064, 95%CI 1.012-1.119)、D-D(OR=1.045, 95%CI 1.027-1.064)是导致COVID-19患者死亡的独立危险因素(P均<0.05)。36（25.4%）例患者进行了低分子肝素抗凝治疗，平均疗程9.6 d。观察组栓塞事件复合发生率为7例（41.2%），其中2例（11.8%）患者伴发深静脉血栓形成（DVT）和肺栓塞（PE），3例（17.6%）伴发脑梗死，2例（11.8%）心肌梗死，较对照组的2例（1.6%）有显著性差异。3例（17.6%）死亡患者合并有显性弥散性血管内凝血（DIC）.
结论: COVID-19重症患者通常存在多种血栓事件的危险因素，存在出凝血功能障碍的患者死亡率较高，疾病进展速度快，应动态监测凝血指标，积极进行机械及药物预防.