血栓弹力图呈持续凝血功能障碍对儿童脓毒症严重程度的分析  

Prediction and analysis of sepsis and MODS severity by thromboelastography with continuous coagulation dysfunction

作　　者：赵伊婷[1] 马洁 杨晓辉[1] 黎立 ZHAO Yiting;MA Jie;YANG Xiaohui;LI Li(The Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi,830002,China;Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine)

机构地区：[1]新疆医科大学第六附属医院,乌鲁木齐830002 [2]新疆维吾尔自治区中医医院

出　　处：《临床血液学杂志（输血与检验）》2020年第6期832-835,共4页Journal of Clinical Hematology(Blood Transfusion & Laboratory Medicine)

摘　　要：目的:分析血栓弹力图(TEG)结果呈持续凝血功能障碍状态对儿童脓毒症和多器官功能障碍综合征(MODS)严重程度的预测价值。方法:回顾性分析127例脓毒症患儿的临床资料,根据患儿病情程度的不同,分为A组(脓毒症)85例和B组(严重脓毒症)42例,比较A、B组患儿入院第1、3天TEG检查结果。比较不同凝血功能状态的患儿入院当天血常规、血生化和儿童多器官功能障碍评分等差异。结果:与A组比较,B组TEG结果提示为持续低凝状态,其中凝血综合指数(CI)、最大血块强度(MA)均明显下降,血块形成速率(α)明显减少,凝血时间(R)、血块形成速率(K)明显延长(P<0.01)。根据患儿凝血功能状态检测结果,凝血功能异常87例,包括低凝33例(低凝组),高凝54例(高凝组)。低凝组中性粒细胞绝对计数(ANC)明显低于高凝组(t=10.14,P<0.01),丙氨酸氨基转移酶(ALT)、血尿素氮(BUN)和血肌酐(SCr)含量明显高于高凝组(t=36.06、14.51、12.24,均P<0.01)。低凝组儿童多器官功能障碍评分明显高于高凝组(t=27.85,P<0.01),入院3 d内器官功能障碍累积数目明显多于高凝组(t=28.56,P<0.01),入院4周死亡率(36.36%)明显高于高凝组(7.41%)(χ^(2)=9.59,P<0.01)。结论:TEG检查结果提示持续凝血功能障碍状态可有效评估儿童脓毒症和MODS严重程度,提示TEG对儿童脓毒症和MODS严重程度及预后的早期评估具有一定的预测价值。Objective:To analyze the predictive value of continuous coagulation dysfunction in children with sepsis and multiple organ dysfunction syndrome(MODS)by thromboelastography(TEG). Method:The clinical data of 127 children with sepsis in our hospital were retrospectively analyzed.According to the severity of sepsis,they were divided into group A(85 cases of sepsis)and group B(42 cases of severe sepsis).The results of TEG were compared on the 1 st and 3 rd day after admission in group A and B,and the differences of blood routine,blood biochemistry and children’s multiple organ dysfunction scores were compared on the day of admission in children with different coagulation status. Result:Compared with group A,TEG results in group B indicated a continuous hypocoagulation state,in which CI and MA decreased significantly,α reduced significantly,K and R prolonged significantly(P<0.01).According to the coagulation function of the children,there were 87 cases of abnormal coagulation function,including 33 cases of hypocoagulation(hypocoagulation group)and 54 cases of hypercoagulation(hypercoagulation group).The absolute neutrophil count(ANC)in the hypocoagulation group was significantly lower than that in the high coagulation group(t= 10.14,P<0.01),and the levels of alanine aminotransferase(ALT),blood urea nitrogen(BUN)and creatinine(SCr)in the hypocoagulation group were significantly higher than those in the hypercoagulation group(t= 36.06,14.51,12.24,all P<0.01).The score of multiple organ dysfunction in hypocoagulation group was significantly higher than that in hypercoagulation group(t= 27.85,P<0.01).The cumulative number of organ dysfunction in 3 days after admission was significantly higher than that in hypercoagulation group(t=28.56,P<0.01).The 4-week mortality rate(36.36%)in hypocoagulation group was significantly higher than that in hypercoagulation group(7.41%)(χ^(2) = 9.59,P<0.01).Conclusion:TEG examination results suggested that the status of continuous coagulation dysfunction could effectively assess the sever

关 键 词：血栓弹力图 凝血功能 脓毒症 多器官功能障碍综合征 儿童 预测价值 

分 类 号：R157.1[医药卫生—营养与食品卫生学]