摘要
目的探讨脓毒症患儿早期凝血功能及4种弥散性血管内凝血(DIC)评分系统与病情严重程度及出院转归的关系。方法回顾性分析2015年5月4日至2016年12月31日于该院住院的脓毒症患儿入儿童重症监护室(PICU)24 h内的DIC实验室指标资料。分别比较不同严重程度脓毒症组间DIC实验室指标变化,并分析不同DIC诊断评分系统与脓毒症严重程度及出院转归的关系。结果随着脓毒症严重程度加重,血小板(PLT)、纤维蛋白原(Fg)、抗凝血酶Ⅲ(ATⅢ)逐渐降低,各组间Fg比较无明显差异(P=0.074);凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)逐渐延长(P<0.05),国际标准化比值(INR)、D-二聚体(DDI)、纤维蛋白原降解产物(FDP)水平逐渐升高(P<0.05)。随着脓毒症病情加重,DIC发生率均逐渐增加;国际血栓形成与止血学会(ISTH)、日本卫生福利部(JMHW)、中国DIC诊断评分系统(CDSS)诊断不同严重程度脓毒症患儿DIC的发生情况比较,差异均有统计学意义(P<0.05);日本急诊医学会(JAAM)评分系统诊断不同严重程度脓毒症患儿的DIC发生情况比较,差异无统计学意义(P>0.05)。ISTH、JAAM、JMHW、CDSS评分系统诊断DIC患儿的病死率分别为19.1%、10.1%、17.5%、11.6%(P<0.05),约为非DIC患者病死率的3.9、1.6、4.0、2.2倍,4种评分系统诊断DIC患儿的病死率组间比较无明显差异(P>0.05)。结论随着脓毒症严重程度增加,DIC实验室指标水平均逐渐变差,4种DIC评分系统DIC的诊断发生率均逐渐增加,病死率增加。4种评分系统有利于评估脓毒症诱发DIC的预后,且JAAM或CDSS评分系统可能更有助于DIC的早期识别。
Objective To explore the relationships between coagulation function,four kinds of disseminated intravascular coagulation(DIC)scoring systems in children at the early onset of sepsis and severity of the disease and outcome of discharge.Methods A retrospective analysis of the DIC laboratory indicators of children with sepsis who were admitted to the Child Intensive Care Unit(PICU)within 24 h in this hospital from May 4,2015 to December 31,2016 was conducted.The changes of DIC laboratory indicators in different severity of sepsis groups were compared,and the relationships between different DIC diagnostic scoring systems and the severity of sepsis and outcomes of discharge were analyzed.Results As the severity of sepsis aggravated progressively,the platelets(PLT)count,levels of fibrinogen(Fg)and antithrombinⅢ(ATⅢ)gradually decreased,and no statistically significant difference was found in Fg among different severity of sepsis groups(P=0.074);prothrombin time(PT),activated partial thromboplastin time(APTT)and thrombin time(TT)gradually prolonged(P<0.05);the international normalized ratio(INR),levels of D-dimer(DDI)and fibrinogen degradation products(FDP)gradually increased(P<0.05).With the aggravation of sepsis,the incidence of DIC increased gradually.The incidence of DIC in children with sepsis of different severity diagnosed by using the International Societyon Thrombosisand Haemostasis(ISTH),Japanese Ministry of Health and Welfare(JMHW)and Chinese DIC scoring system(CDSS)scoring systems was statistically significant different(P<0.05),while no statistically significant difference was found in the incidence of DIC in children with sepsis of different severity diagnosed by using the Japanese Association for Acute Medicine(JAAM)scoring system(P>0.05).The mortality rates of children diagnosed with DIC by using ISTH,JAAM,JMHW,and CDSS scoring systems were 19.1%,10.1%,17.5%,and 11.6%,respectively(P<0.05),which were approximately 3.9,1.6,and 1.6 times of those of non-DIC children.There was no significant difference in mortality of children diagnosed with DIC by using the four scoring systems(P>0.05).Conclusion With the increasing severity of sepsis,the levels of DIC laboratory indicators gradually deteriorated.The incidence of DIC diagnosed by using the four DIC diagnostic scoring systems and mortality increased gradually.Four DIC scoring systems are helpful for evaluating the prognosis of DIC induced by sepsis,and JAAM or CDSS scoring system may be more helpful in early identification of DIC.
作者
杨敏
李德渊
刘忠强
罗黎力
乔莉娜
YANG Min;LI Deyuan;LIU Zhongqiang;LUO Lili;QIAO Lina(Department of Pediatric,West China Second University Hospital,Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University),Ministry of Education,Chengdu,Sichuan 610041,China)
出处
《重庆医学》
CAS
2020年第14期2289-2294,共6页
Chongqing medicine
基金
四川省学术和技术带头人培养和支持项目[川人社办发(2017)919-23]
四川省科技计划项目(2019YFS0245)
四川大学华西第二医院新芽基金(kx010)。
关键词
脓毒症
重症监护病房
儿科
弥散性血管内凝血
评分系统
早期诊断
sepsis
intensive care unit,pediatric
disseminated intravascular coagulation
scoring system
early diagnosis
作者简介
杨敏(1989-),主治医师,硕士,主要从事儿科学儿童重症医学研究;通信作者:乔莉娜,E-mail:iaqiao@163.com。
