血栓弹力图对儿童严重急性骨关节感染后脓毒症并发弥散性血管内凝血的诊断价值  

Diagnostic value of thromboelastography in children with sepsis complicated with DIC after severe acute osteoarthritis

作　　者：冯彦华 任强 毛振 罗鹏远 郝建宗[1] 崔硬铁[1] 张放[1] 李京宴 Feng Yanhua;Ren Qiang;Mao Zhen;Luo Pengyuan;Hao Jianzong;Cui Yingtie;Zhang Fang;Li Jingyan(Department of Orthopedics,The Children’s Hospital of Hebei Province,Hebei Shijiazhuang 050000,China;Department of Emergency,The Second Hospital of Hebei Medical University,Hebei Shijiazhuang 050000,China)

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

出　　处：《中国医刊》2021年第12期1316-1319,共4页Chinese Journal of Medicine

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(thromboelastography,TEG)对儿童严重急性骨关节感染后脓毒症并发弥散性血管内凝血(disseminated intravascular coagulation,DIC)的诊断价值。方法选取2017年1月至2020年1月河北省儿童医院收治的严重急性骨关节感染后脓毒症患儿86例,根据是否并发DIC分为DIC1组44例、非DIC组42例,另选同期来院体检的健康儿童40例为对照组,检测血小板(platelet,PLT)、凝血酶原时间(prothrombin time,PT)、活化部分凝血酶原时间(activated partial thromboplastin time,APTT)及TEG。另选2014年1月至2016年12月河北省儿童医院收治的严重急性骨关节感染后脓毒症并发DIC患儿41例为DIC2组,该组仅检测PLT、PT、APTT。结果DIC1组PT、APTT长于非DIC组和对照组,PLT低于非DIC组及对照组,差异有显著性(P<0.001);非DIC组PT、APTT长于对照组,PLT低于对照组,差异有显著性(P<0.001)。DIC1组凝血反应时间、凝血形成时间长于非DIC组及对照组,凝固角、最大振幅、综合凝血指数小于非DIC组及对照组,差异有显著性(P<0.001);非DIC组凝血反应时间、凝血形成时间短于对照组,凝固角、最大振幅、综合凝血指数大于对照组,差异有显著性(P<0.001)。DIC1组和DIC2组PLT、PT、APTT比较差异无显著性(P>0.05);DIC1组住院时间短于DIC2组,差异有显著性(P=0.000);DIC1组死亡0例,DIC2组死亡5例,两组比较差异有显著性(P=0.023)。结论TEG对儿童严重骨关节感染后脓毒症并发DIC的诊断具有积极意义,可以评价患儿出现血栓及出血风险,指导临床治疗并改善预后。Objective To evaluate the value of thromboelastography(TEG)in the diagnosis of sepsis complicated with disseminated intravascular coagulation in children with severe acute osteoarticular infection.Method From January 2017 to January 2020,86 children with sepsis after acute infection of bone and joint.Divided into DIC1 group(44 cases),non-DIC group(42 cases)and normal control group(40 cases),platelet count(PLT),prothrombin time(PT),activated partial thromboplastin time(APTT)and TEG were measured in all patients.DIC2 group was composed of 41 children with septic DIC after severe acute infection of bone and joint from January 2014 to December 2016.Only PLT,PT and APTT were detected.Result PT and APTT in DIC1 were longer than those in non-DIC group and normal control group,and PLT in DIC1 group was lower than those in non-DIC group and normal control group(P<0.001).PT and APTT in non-DIC Group was significantly longer than that in normal control group(P<0.001),and the level of PLT in non-DIC group was significantly lower than that in normal control group(P<0.001).The R time and K time in group DIC1 were higher than those in non-DIC Group and normal control group,and the angle,MA value and CI value were lower than those in non-DIC group and normal control group(P<0.001);the R time,K time in non-DIC group were lower than that in normal control group,and the angle,MA and CI value were higher than that in normal control group(P<0.001).There was no significant difference in PLT,PT and APTT between DIC1 group and DIC2 Group(P>0.05);DIC1 group had shorter hospital stay than DIC2 group,and the difference was statistically significant(P=0.000);DIC1 group had no dead cases,DIC2 group had 5 dead cases,the difference was statistically significant(P=0.023).Conclusion TEG has a positive role in the diagnosis of DIC in children with severe osteoarthritis,which can evaluate the risk of thrombosis and hemorrhage,guide clinical treatment and improve prognosis.

关 键 词：血栓弹力图 儿童骨关节感染 脓毒症 凝血功能 

分 类 号：R725[医药卫生—儿科]