手足口病危重症凝血功能监测的意义  

The significance of monitoring blood coagulation function in children with severe hand,foot and mouth disease

作　　者：王晓冬[1] 霍习敏[1] 徐梅先[1] 张银瑞[1] 耿文锦[1] 曹丽静[1] 孙慧[1] 郭艳梅[1] 李君娥[1] 康磊[1] 

机构地区：[1]河北省儿童医院重症监护科,河北 石家庄050031

出　　处：《中国中西医结合急救杂志》2014年第1期26-30,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：河北省科技支撑计划项目（122777128）

摘　　要：目的：观察手足口病危重症患儿凝血系统状态与肺出血的关系，探讨临床凝血指标的早期诊断意义。方法采用前瞻性病例设计方法，选择2010年7月至2012年7月河北省儿童医院重症医学科收治的手足口病重型病例89例，按其严重程度分为重症组（46例）及危重症组（43例），将危重症组再按预后分为生存组26例和死亡组17例；健康对照组为同期44例同龄健康儿童。患儿入院后立即取血，进行血常规、凝血酶原时间（PT）、凝血酶时间（TT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（Fg）及D-二聚体检测。结果重症组、危重症组和健康对照组PT、TT、APTT及Fg水平差异均无统计学意义（均P＞0.05），重症组和危重症组血小板计数（PLT）明显低于健康对照组（＆#215;109/L：245＆#177;130、237＆#177;156比389＆#177;120），D-二聚体明显高于健康对照组（mg/L：0.34＆#177;0.67、0.41＆#177;0.08比0.24＆#177;0.13），且危重症组D-二聚体高于重症组（均P＜0.05）。危重症组病死率为39.5%，存活组和死亡组PT、APTT、Fg、TT及PLT比较差异均无统计学意义（均P＞0.05），而死亡组D-二聚体水平明显低于存活组（mg/L：0.60＆#177;0.09比0.12＆#177;0.09，P＜0.05）。结论重症及危重症手足口病凝血因子及血小板处于启动动员状态、轻度消耗状态，并存在纤溶抑制状态，尚未出现全身出血倾向，即处于弥散性血管内凝血（DIC）代偿期，不是肺出血的发生机制；监测D-二聚体对病情评估有临床意义。Objective To investigate the relationship between the coagulation system status and the pulmonary hemorrhage in children with severe hand,foot and mouth disease（HFMD）and approach the clinical significance of early detection of coagulation function. Methods By prospective case design method,89 cases with HFMD admitted to Department of Critical Care Medicine of Hebei Provincial Children Hospital from July 2010 to July 2012 were enrolled. The children were divided into severe group（46 cases）and critical group（43 cases）according to the severity of disease,and the children in critical group were subdivided into survivor group（26 cases）and non-survivor group （17 cases）. Forty-four healthy children with the same age and in the same period were served as healthy control group. The blood of children was collected immediately after admission for determination of blood routine, prothrombin time（PT）,thrombin time（TT）,activated partial thrombin time（APTT）,fibrinogen（Fg）,and D-dimer （DD）. Results There were no significant differences in PT,TT,APTT and Fg among severe group,critical group and health control group（all P＆gt;0.05）. The blood platelets count（PLT）in severe group and critical group was significantly lower than that in health control group（＆#215;109/L：245＆#177;130,237＆#177;156 vs. 389＆#177;120）,while the DD was significantly higher than that in healthy control group（mg/L：0.34＆#177;0.67,0.41＆#177;0.08 vs. 0.24＆#177;0.13）,and the DD in critical group was obviously higher than that in severe group（all P＆lt;0.05）. The mortality rate in critical group was 39.5%,and there were no significant differences in PT,APTT,Fg,TT and PLT between survivor group and non-survivor group（all P＆gt;0.05）,but the DD in non-survivor group was significantly lower than that in survivor group（mg/L：0.60＆#177;0.09 vs. 0.12＆#177;0.09,P＆lt;0.05）. Conclusions In children with severe or critical HFMD, the coagulation factor and blood platelet were in a

关 键 词：手足口病 危重症 儿童 凝血状态 肺出血 

分 类 号：R459.7[医药卫生—急诊医学]