摘要
目的探讨血栓弹力图(TEG)在儿童重症支原体肺炎(SMPP)凝血监测中的价值。方法选取2016年1月至2019年12月入住河南省儿童医院儿科重症监护室(PICU)的37例SMPP患儿为研究对象,根据是否合并栓塞分为合并血栓组和未合并血栓组,其中合并栓塞组13例,未合并栓塞组24例。患儿入院后按照病情接受常规治疗,阿奇霉素抗感染(如合并细菌感染时加用β内酰胺类抗生素或碳氢酶烯类抗生素)、机械通气、维持内环境、营养支持、血液净化、抗凝等综合治疗。所有纳入研究的患儿均在入住PICU第1天、第3天、第5天、第7天、第9天、第11天、第13天常规监测凝血四项、D-二聚体和TEG,根据病情进行其他监测。结果入院后第1天、第3天、第5天、第7天、第9天、第11天、第13天合并血栓组D-二聚体高于未合并血栓组(P<0.05)。合并血栓组的凝血反应时间(R值)低于未合并血栓组(P<0.05);合并血栓组的血凝块形成时间(K值)低于未合并血栓组(P<0.05);合并血栓组凝固角(α角)高于未合并血栓组(P<0.05);合并血栓组最大振幅(MA)高于未合并血栓组(P<0.05);合并血栓组凝血综合指数(CI值)高于未合并血栓组(P<0.05)。合并血栓患儿D-二聚体与R值、K值呈负相关(r=-0.791、-0.816,P<0.05),与α角、MA值、CI值呈正相关(r=0.893、0.725、0.691,P<0.05)。TEG中各指标与D-二聚体对合并血栓的患儿诊断的敏感性差异无统计学意义(P>0.05);TEG中各指标较D-二聚体对合并血栓的患儿诊断的特异性高(P<0.05);TEG中各指标较D-二聚体对SMPP合并血栓的患儿诊断指数高(P<0.05)。结论TEG在儿童SMPP凝血监测中具有较好的价值,尤其是在合并血栓的患儿中具有较好的特异性和敏感性,可为临床干预提供指导。
Objective To explore the value of thromboelastography(TEG)in the monitoring of coagulation in severe mycoplasma pneumonia(SMPP)in children.Methods A total of 37 cases of children with SMPP admitted to the Pediatric Intensive Care Unit(PICU)of Henan Children’s Hospital from January 2016 to December 2019 were selected as the study subjects.According to the combination of embolism or not,they were divided into the group with thrombosis and the group without thrombosis,including 13 cases with embolism and 24 cases without embolism.After admission,they were given conventional treatment,according to their condition of illness,azithromycin resistance to infection(such as merger bacterial infection with beta lactam antibiotics or hydrocarbon enzyme alkene),mechanical ventilation,maintain internal environment,nutritional support,blood purification,anticoagulation and other comprehensive treatment.Coagulation function,D-dimer and TEG were respectively detected in PICU on the 1st,3rd,5th,7th,9th,11th and 13th days after admission.Other indicators were monitored according to the condition.Results On the 1st,3rd,5th,7th,9th,11th and 13th day after admission,the D-dimer of the group with thrombosis were higher than that of the group without thrombosis(P<0.05).Coagulation reaction time(R value)of the group with thrombus were lower than that of the group unincorporated thrombus(P<0.05).Coagulation time(K value)of the group with thrombus were lower than that of the group unincorporated thrombus(P<0.05).Coagulation angle(αangle)in the group with thrombus were higher than that in the group unincorporated thrombus(P<0.05).Maximum amplitude(MA value)of the group with thrombus were higher than that of the group unincorporated thrombus(P<0.05).Coagulation composite index(CI value)of the group with thrombus were higher than that of the group unincorporated thrombus(P<0.05).In children combined with thrombus,D-dimer was negatively correlated with R value and K value(r=-0.791,-0.816,P<0.05),and was positively correlated withαangle,MA
作者
崔利丹
金志鹏
苏军
王琪
陈晨
CUI Lidan;JIN Zhipeng;SU Jun;WANG Qi;CHEN Chen(Department of Pediatric Intensive Care Unit,Children’s Hospital Affiliated to Zhengzhou University/Henan Children’s Hospital/Zhengzhou Children’s Hospital,Zhengzhou 450018,China)
出处
《河南医学研究》
CAS
2021年第21期3861-3865,共5页
Henan Medical Research
基金
郑州市2015科技发展计划(20150151)。
关键词
血栓弹力图
儿童
重症支原体肺炎
凝血
thrombelastography
child
severe mycoplasma pneumonia
coagulation function
