血栓弹力图在儿童严重软组织感染后脓毒症并发弥漫性血管内凝血诊断中的应用价值  

Application Value of Thromboelastogram in Diagnosis of Children with Sepsis Complicated by DIC after Severe Soft Tissue Infection

作　　者：冯彦华 张放[1] 邵智利[2] 李京宴 郝建宗[1] 甄磊[1] 崔硬铁[1] 何明哲[1] 田苡仁 商浩[1] 王康 谢东晓 赵玺段[1] 陈秋敬 FENG Yan-hua;ZHANG Fang;SHAO Zhi-li;LI Jing-yan;HAO Jian-zong;ZHEN Lei;CUI Ying-tie;HE Ming-zhe;TIAN Yi-ren;SHANG Hao;WANG Kang;XIE Dong-xiao;ZHAO Xi-duan;CHEN Qiu-jing(The First Department of Orthopedics,the Children's Hospital of Hebei Province,Shijiazhuang 050000,China;Department of Transfusion,1.the Children's Hospital of Hebei Province,Shijiazhuang 050000,China;Department of Emergency,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北省儿童医院骨一科,石家庄050031 [2]河北省儿童医院输血科,石家庄050031 [3]河北医科大学第二医院急诊科,石家庄050000

出　　处：《临床误诊误治》2021年第6期91-95,共5页Clinical Misdiagnosis & Mistherapy

基　　金：河北省医学科学研究重点课题计划(20170394)。

摘　　要：目的评价血栓弹力图(TEG)对儿童严重软组织感染后脓毒症并发弥漫性血管内凝血(DIC)的诊断价值。方法选择2017年1月—2019年12月收治的严重软组织感染后脓毒症患儿31例,根据是否并发DIC分为DIC1组18例、非DIC组13例;选择同期正常儿童12例为对照组。3组均检测血小板(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及TEG并进行比较。另选2014年1月—2016年12月收治的严重软组织感染后脓毒症并发DIC患儿16例为DIC2组,该组只检测PLT、PT、APTT。比较DIC1组和DIC2组的凝血指标、住院时间和病死率。结果DIC1组PT、APTT水平高于非DIC组及对照组,PLT水平低于非DIC组及对照组(P<0.01)。非DIC组PT、APTT水平高于对照组,PLT水平低于对照组(P<0.01)。DIC1组凝血反应时间(R时间)、凝血形成时间(K时间)高于非DIC组及对照组,凝固角(α角)、最大振幅(MA值)、综合凝血指数(CI值)低于非DIC组及对照组(P<0.01)。非DIC组R时间、K时间低于对照组,α角、MA值及CI值高于对照组(P<0.01)。DIC1组和DIC2组PLT、PT、APTT水平比较差异无统计学意义(P>0.05)。DIC1组住院时间短于DIC2组,病死率低于DIC2组(P<0.01,P<0.05)。结论TEG对儿童严重软组织感染后脓毒症并发DIC的诊断具有积极意义,可以评价患儿血栓形成及出血风险,指导临床治疗并改善预后。Objective To evaluate application value of thromboelastogram(TEG)in diagnosis of children with sepsis complicated by disseminated intravascular coagulation(DIC)after severe soft tissue infection.Methods A total of 31 children with sepsis after severe soft tissue infection admitted during January 2017 and December 2019 were enrolled,and the patients were divided into DIC1 group(n=18)and non-DIC group(n=13)according to presence or absence of concurrent DIC,while another 12 healthy children at the same period were selected as control group.Levels of platelet count(PLT),prothrombin time(PT),activated partial thromboplastin time(APTT)and TEG were measured and compared among three groups.Another 16 children with sepsis after severe soft tissue infection complicated by DIC admitted during January 2014 and December 2016 were selected as DIC2 group,and values of PLT,PT and APTT were detected in this group.Values of coagulation parameters,length of hospital stay and mortality were compared between DIC1 and DIC2 groups.Results In DIC1 group,PT and APTT levels were significantly higher,while PLT level was significantly lower than those in non-DIC and control groups(P<0.01).In non-DIC group,PT and APTT levels were significantly higher than those in control group,whereas PLT level was significantly lower than that in control group(P<0.01).In DIC1 group,coagulation reaction time(R time)and coagulation formation time(K time)were significantly longer,while values of coagulation angle(αangle),maximum amplitude(MA value)and composite coagulation index(CI value)were significantly lower than those in non-DIC and control groups(P<0.01).In non-DIC group,R time and K time were significantly shorter,while values ofαangle,MA and CI were significantly higher than those in control group(P<0.01).There were no significant differences in PLT,PT and APTT levels between DIC1 and DIC2 groups(P>0.05).DIC1 group had shorter hospital stay and lower mortality compared with those in DIC2 group(P<0.01,P<0.05).Conclusion TEG plays a positive role in d

关 键 词：软组织感染 脓毒症 弥漫性血管内凝血 儿童 血栓弹力图 凝血酶原时间 诊断 

分 类 号：R631[医药卫生—外科学] R554.8[医药卫生—临床医学]