动态监测D-Dime、动脉血乳酸、纤维蛋白原、氧合指数在小儿脓毒血症的临床意义  

Clinical significance of dynamic monitoring of D-dimer,arterial blood lactate,fibrinogen and oxygenation index in infants with septicopyemia

作　　者：江秀清[1] 阙学俊[1] 苏岸华[1] 

机构地区：[1]广西玉林市第一人民医院儿科,537000

出　　处：《中国妇幼保健》2011年第23期3573-3575,共3页Maternal and Child Health Care of China

摘　　要：目的:探讨动态监测D-Dime、动脉血乳酸、纤维蛋白原、氧合指数在小儿脓毒血症的临床意义。方法:将该院2007年4月～2010年4月重症监护室收治的小儿脓毒血症患儿48例作为观察对象,根据预后最终生存34例设立为生存组,死亡14例设立为死亡组。所有患者入ICU后,常规检测凝血五项、动脉血气分析和动脉乳酸值(LA),计算动脉血气氧合指数(PaO2/FiO2)。采用贝克曼DXC800全自动生化仪进行测试取桡动脉血进行血乳酸测定。纤维蛋白原(FBG)的检测:0.109mmoL/L枸橼酸钠抗凝试管取血3mL,Sysmex CA-1500凝血分析仪进行分析。以免疫比浊法测定D-二聚体(DD)。结果:与治疗前相比较,生存组患者PaO2/FiO2治疗后24 h、治疗后48 h、治疗后72 h得到明显改善,且改善效果明显优于死亡组(P<0.05),而生存组的动脉血乳酸随着治疗时间延长分别与治疗前比较呈逐渐下降趋势(P<0.05),而死亡组随着治疗时间的延长逐渐升高。本组病例治疗前DD死亡组较生存组明显增加,差异有统计学意义(P<0.05)。治疗后,随着治疗时间的延长,生存组DD治疗后24h、治疗后48h、治疗后72 h逐渐下降,且生存组下降水平明显优于死亡组(P<0.05)。而纤维蛋白原同DD正好相反。结论:动态监测D-Dime、动脉血乳酸、纤维蛋白原、氧合指数在小儿脓毒血症具有重要的临床意义,可以反映疾病的预后及严重程度。Objective：To explore the clinical significance of dynamic monitoring of D-dimer,arterial blood lactate,fibrinogen and oxygenation index in infants with septicopyemia.Methods：48 infants with septicopyemia from intensive care unit of the hospital from April 2007 to April 2010 were selected as study objects,then they were divided into survival group（34 infants） and death group（14 infants） according to the prognosis.All the infants received coagulation test（five indexes）,arterial blood gas analysis and arterial lactate（LA） detection routinely,arterial blood gas oxygenation index（PaO2/FiO2） was calculated.Beckman DXC800 automatic biochemistry analyzer was used to detect lactate level in radial artery blood.Fibrinogen test： 3 ml blood was placed into anticoagulant test tube with 0.109 mmol/L sodium citrate,then Sysmex CA-1500 coagulation analyzer was used for analysis.Immunoturbidimetry was used to detect D-dimer.Results：Compared with before treatment,the ratios of PaO2/FiO2 in survival group were improved significantly at 24 hours,48 hours and 72 hours after treatment,and the improving effects were better than those in death group（P〈0.05）,but in survival group,compared with before treatment,the lactate level in artery blood showed a decreasing trend with time extension（P〈0.05）,while in death group,the level of lactate in artery blood increased gradually with time extension.Before treatment,D-dimer level in death group was significantly higher than that in survival group（P〈0.05）;D-dimer level in survival group decreased gradually with time extension at 24 hours,48 hours and 72 hours after treatment,and the degree of decreasing was significantly superior to that in death group（P〈0.05）.The change trend of fibrinogen was opposite to D-dimer.Conclusion：Dynamic monitoring of D-dimer,arterial blood lactate,fibrinogen and oxygenation index has important clinical significance for infants with septicopyemia,which may reflect the prognosis and severity of the disease.

关 键 词：动态监测 D—Dime 动脉血乳酸 纤维蛋白原 氧合指数 小儿脓毒血症 

分 类 号：R725.5[医药卫生—儿科]