血栓弹力图在脓毒症及脓毒性休克患儿并弥散性血管内凝血病情评估中的价值  

Effect of thrombelastography on the assessment of sepsis severity and septic shock with disseminated intravascular coagulation condition in children

作　　者：崔利丹 金志鹏 王琪 成怡冰 王群思 

机构地区：[1]郑州儿童医院PICU,450018

出　　处：《中华实用儿科临床杂志》2017年第18期1398-1401,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：郑州市2015年度科技发展计划（20150151）

摘　　要：目的 探讨血栓弹力图（TEG）在儿童脓毒症及脓毒性休克合并弥散性血管内凝血（DIC）病情评估中的价值。方法 选取2013年1月至2016年12月入住郑州儿童医院儿科重症监护室（PICU）的脓毒症（58例）、严重脓毒症（17例）、脓毒性休克（16例，其中合并DIC 7例，非DIC 9例）共91例患儿为研究对象，患儿入院后按照病情进行常规治疗，如扩容补液、应用血管活性药物、抗感染、机械通气、维持内环境、营养支持等治疗。所有纳入研究的患儿均在入院6 h内行血栓弹力图检测。检测指标包括凝血反应时间（R值）、血块生成时间（K值）、血块生成率（α角）、最大宽度值（MA值）、凝血综合指数（CI值）等。并对入选患儿入院6 h内完善小儿危重病例评分（PCIS）。结果 随着脓毒症病情加重，R值、K值逐渐延长（F＝3.829、4.237，均P〈0.05），α角、MA值、CI值逐渐减小（F＝32.631、19.938、10.849，均P〈0.05）；R值、K值与PCIS呈明显正相关（r＝0.591、0.827，均P〈0.05），α角、MA值、CI值与PCIS呈明显负相关（r＝－0.793、－0.827、－0.839，均P〈0.05）。脓毒性休克中DIC组的R值和K值显著大于非DIC组（t＝4.381、2.613，均P〈0.05），平均α角明显小于非DIC组（t＝5.627，P〈0.05）。DIC组的MA值和CI值显著小于非DIC组（t＝5.416、2.951，均P〈0.05）。脓毒性休克组中存活组与死亡组患儿R值、K值、α角、MA值、CI值水平差异均无统计学意义（均P〉0.05）。结论 TEG在评估脓毒症患儿的病情严重程度中具有一定的价值，在脓毒性休克患儿合并DIC时也可指导进行临床评估，从而给予有效准确的干预治疗，提高抢救成功率，改善预后。Objective To explore the effect of thrombelastography in sepsis and septic shock with disseminated intravascular coagulation （DIC） condition in children.Methods Ninety-one cases of children admitted to the Pediatric Intensive Care Unit, Zhengzhou Children′s Hospital between January 2013 and December 2016 were enrolled in this study.Fifty-eight cases of sepsis, 17 cases of severe sepsis and 16 cases of septic shock （including 7 cases DIC and 9 cases non-DIC） were included in 91 cases of children.After admission, they were given conventional treatment according to their condition of illness, such as expansion of rehydration, applying vascular active drugs, anti-infection, mechanical ventilation, maintaining internal environment, nutrition support, etc.Thrombelastography of all the patients were detected for 6 hours after admission.The test indexes included blood coagulation reaction time （R）, blood clot formation time （K） and blood clot formation rate （alpha）, maximum width （MA）, coagulation index （CI）, etc.And pe-diatric critical illness scores（PCIS） were also evaluated for 6 hours after admission.Results With the progression of sepsis severity, R value, K value increased dramatically（F=3.629, 4.237, all P〈0.05）, alpha angle, MA value, CI value decreased （F=32.631, 19.938, 10.849, all P〈0.05）; R value, K value and PCIS scores showed a significant positive correlation （r=0.591, 0.827, all P〈0.05）, alpha angle, MA value, CI and PCIS scores showed a significant negative correlation （r=-0.793, -0.827, -0.839, all P〈0.05）. R and K values in DIC group were significantly greater than the values of non-DIC group （t=4.381, 2.613, all P〈0.05）, alpha angle was less than that of DIC group obviously （t=5.627, P〈0.05）. In DIC group MA and CI levels were significantly less than those of non-DIC group （t=5.416, 2.951, all P〈0.05）. R value, K value, alpha Angle, MA, CI levels between the dead and surviving patients in the septic shock group had no signific

关 键 词：血栓弹力图 儿童 脓毒症 小儿危重病例评分 弥散性血管内凝血 

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