摘要
目的:对照研究枸橼酸与肝素抗凝对连续性血液净化(CBP)脓毒性休克患儿凝血功能及疗效的影响,为脓毒性休克患儿CBP抗凝提供指导。方法:采用病例对照研究方法,选择2019年7月至2022年9月赣南医学院第一附属医院儿科重症监护病房(PICU)收治的37例脓毒性休克患儿作为研究对象。根据不同抗凝方式分为枸橼酸局部抗凝组和肝素全身抗凝组。收集患儿的一般资料及治疗前和CBP撤机后1 d凝血指标〔凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fib)、D-?二聚体〕和血清炎症介质〔白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C-反应蛋白(hs-CRP)、降钙素原(PCT)〕水平,以及CBP时出血并发症和7 d病死率。结果:37例患儿均纳入最终分析,其中接受枸橼酸局部抗凝17例,肝素全身抗凝20例。两组患儿性别、年龄、体质量等一般资料差异均无统计学意义。两组患儿治疗前凝血指标及炎症介质等基线水平差异均无统计学意义。CBP撤机后1 d,两组凝血指标均较治疗前有不同程度改善。与治疗前比较,肝素全身抗凝组撤机后1 d PT明显缩短(s:11.82±2.05比13.64±2.54),APTT和TT明显延长〔APTT(s):51.54±12.69比35.53±10.79,TT(s):21.95±4.74比19.30±3.33〕,D-二聚体水平明显降低(mg/L:1.92±1.58比4.94±3.94),差异均有统计学意义(均 P<0.05);而枸橼酸局部抗凝组治疗后仅APTT较治疗前明显延长(s:49.28±10.32比34.34±10.32, P<0.05),其他凝血指标与治疗前比较差异均无统计学意义。与枸橼酸局部抗凝组比较,肝素全身抗凝组治疗后PT显著缩短(s:11.82±2.05比13.61±3.05, P<0.05),D-二聚体水平显著降低(mg/L:1.92±1.58比3.77±2.38, P<0.01)。两组CBP撤机后1 d炎症介质水平均较治疗前显著降低〔枸橼酸局部抗凝组:hs-CRP(mg/L)为12.53±5.44比22.65±7.27,PCT(μg/L)为1.86±1.20比3.30±2.34,IL-6(ng/L)为148.48±34.83比202.32±48.62,TNF-�
Objective To compare the effects of citrate and heparin anticoagulation on coagulation function and efficacy in children with septic shock undergoing continuous blood purification(CBP),and to provide guidance for CBP anticoagulation in children with septic shock.Methods A case control study was conducted.Thirty-seven children with septic shock admitted to the pediatric intensive care unit(PICU)of the First Affiliated Hospital of Gannan Medical University from July 2019 to September 2022 were enrolled as the research subjects.The patients were divided into citrate local anticoagulation group and heparin systemic anticoagulation group according to different anticoagulation methods.The baseline data,the level of coagulation indicators[prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(Fib),D-dimer]before treatment and 1 day after weaning from CBP,serum inflammatory mediators[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),hypersensitivity C-reactive protein(hs-CRP),procalcitonin(PCT)],bleeding complications during CBP and 7-day mortality were collected.Results A total of 37 cases were enrolled finally,including 17 cases with citric acid local anticoagulation and 20 cases with heparin systemic anticoagulation.There was no statistically significant difference in general data such as gender,age,and body weight of children between the two groups.There were no statistically significant differences in baseline levels of coagulation indicators and inflammatory mediators before treatment of children between the two groups.One day after weaning from CBP,both groups showed varying degrees of improvement in coagulation indicators compared with those before treatment.Compared with before treatment,the PT of the heparin systemic anticoagulation group was significantly shortened after 1 day of weaning(s:11.82±2.05 vs.13.64±2.54),APTT and TT were significantly prolonged[APTT(s):51.54±12.69 vs.35.53±10.79,TT(s):21.95±4.74 vs.19.30±3.33],D-dimer level was significantly reduced(mg
作者
钟小明
罗沙沙
任瑞华
赖洁
邓国平
朱惠芳
Zhong Xiaoming;Luo Shasha;Ren Ruihua;Lai Jie;Deng Guoping;Zhu Huifang(Department of Pediatric Intensive Care Unit,the First Affiliated Hospital of Gannan Medical University,Gannan 341000,Jiangxi,China;Ganzhou Key Laboratory of Immunotherapy Drugs Developing for Children Leukemia,Ganzhou 341000,Jiangxi,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2023年第8期856-859,共4页
Chinese Critical Care Medicine
基金
江西省卫生健康委科技计划项目 (20204503)。
