急危重患儿弥散性血管内凝血的早期监测研究  

The monitoring of disseminated intravascular coagulation in critically sick children

作　　者：徐南平[1] 吴卫萍[1] 林敏[1] 钟立群[1] 朱友荣[1] 黄雪英[1] 

机构地区：[1]江西省儿童医院急诊科,南昌330006

出　　处：《中国小儿急救医学》2008年第1期32-35,共4页Chinese Pediatric Emergency Medicine

基　　金：江西省卫生厅科技计划项目（0303111）

摘　　要：目的探讨急危重患儿弥散性血管内凝血（DIC）的监测方法及小儿危重病例评分与DIC的内在关系。方法随机对我院PICU新入院的急危重患儿在入院24h内进行首次小儿危重病例评分，根据分值不同依次分成三组：非危重组（〉80分）32例；危重组（71～80分）29例；极危重组（≤70分）23例。评分后按照试验要求应用发色底物法测定抗凝血酶III活性（AT—III：A）；用ELISA法测定D-二聚体和P-选择素水平。结果三组共收集病例84例，其中22例合并DIC，占26％。危重组和极危重组DIC的发生率明显高于非危重组（x^2=6．32，12．82，P值均〈0．05）。而且首次小儿危重病例评分值越低，DIC的发生率就越高（x^2=27．01，P〈0．01）。22例DIC患儿的AT-III：A降低，而D．二聚体、P一选择素均显著升高，敏感性高达90％以上，明显高于血小板计数、凝血酶原时间和纤维蛋白原等指标（x^2=35．22，P〈0．01）。结论小儿危重病例评分可用于急危重患儿DIC的早期监测，对科学把握DIC早期实验室检测的有利时机有重要的临床意义；D-二聚体、AT-III：A、P-选择素作为急危重患儿DIC的早期监测指标，有较高的敏感性和特异性。Objective To investigate the monitoring metheds of disseminated intravascular coagulation （DIC） in critically sick children, and to study the relationship between the pediatric illness scoring （PICS） and DIC. Methods Critically sick children admitted in PICU of Jiangxi Children＇s Hospital were randomly scored by PICS on the admission day. They were divided into three groups according to different scores ：32 cases with non-serious degree （scoring 〉80）, 29 cases with serious degree （scoring 71--80） and 23 cases with extremely serious degree （scoring ≤70）. The activity of AT-III：A was measured by chromogenic substrate method after first PICS. The quantity of D-dimer and P-selectin were measured by enzyme linked immumsorbent assay. Results Among 84 cases in the three groups, 22 DIC cases were enrolled. Serious and extremely serious groups showed significantly higher incidence than non-serious group（x^2 = 6.32, 12.82, P 〈 0.05 ）. The DIC incidence raised as an increase in PICS score on admission day （x^2 = 27.01, P 〈 0.01 ）. In addition, the AT- III：A activity was lower, but D-dimer and P-selectin level were higher in DIC group and their sensitivity were higher （over 90 % ） than that of BPC （45.5 % ）, PT （57.1% ） and FIB （20 % ） （2 = 35.22, P 〈 0.01）. The AT-III：A activity of was lower, but D-dimer and P-selectin level were significantly higher in serious and extremely serious groups than that of non-serious group （P 〈 0.01）. Conclusion P ICS plays an important role in DIC moritoring among critically ill children. AT- III： A, D- dimer and P-selectin are significantly sensitive and specific indicators for early DIC monitoring and diagnosis.

关 键 词：弥散性血管内凝血 小儿危重病例评分 D-二聚体 抗凝血酶III活性 P-选择素 

分 类 号：R720.597[医药卫生—急诊医学] R725.5[医药卫生—儿科]