【摘要】：目的通過檢測重癥肺炎患兒常見的能反映凝血功能的相關(guān)指標(biāo),總結(jié)重癥肺炎患兒的凝血指標(biāo)的變化和特點,評估重癥肺炎患兒的凝血狀態(tài);同時分析各凝血指標(biāo)與小兒危重病例評分(PCIS)在評估重癥肺炎患兒病情中的相關(guān)性;以期為早期識別危重患兒,為及時干預(yù)提供理論依據(jù)。方法隨機(jī)選取2015年10月到2016年10月在延安大學(xué)附屬醫(yī)院兒科住院的肺炎患兒,根據(jù)病情分為普通肺炎組(30例)及重癥肺炎組(30例),并同期選取一般條件匹配的健康兒童作為對照組檢測凝血系列(包括PT、APTT、FIB、FDP、D-D)及血小板參數(shù)(包括PLT、MPV)進(jìn)行比較;對入選的重癥肺炎患兒進(jìn)行PCIS評分,按得分結(jié)果分為極危重組(≤70分)、危重組(71~80分)及非危重組(80分),比較各組凝血指標(biāo)的變化及DIC的發(fā)生率;分析凝血指標(biāo)與PCIS的相關(guān)性。結(jié)果1.重癥肺炎組、普通肺炎組與正常對照組兒童的年齡、性別及體重的組間比較均無統(tǒng)計學(xué)意義(P0.05),差異不明顯。2.肺炎組與對照組凝血指標(biāo)的比較,除MPV外,余各指標(biāo)水平在重癥肺炎組、普通肺炎組及對照組中差異有統(tǒng)計學(xué)意義(P0.05),差異明顯;普通肺炎組APTT、FIB及D-D較對照組比較有統(tǒng)計學(xué)意義(P0.017),差異明顯;余各指標(biāo)在在兩組間差異均無統(tǒng)計學(xué)意義(P0.017),變化不明顯。3.重癥肺炎組與普通肺炎組相關(guān)凝血指標(biāo)異常率的比較,重癥肺炎組較普通肺炎組除外MPV余各指標(biāo)的差異率比較有統(tǒng)計學(xué)意義(P0.05),重癥肺炎組指標(biāo)的差異率較普通肺炎組升高明顯。4.極危重組、危重組及非危重組各凝血指標(biāo)的比較,PLT在三組中比較有統(tǒng)計學(xué)意義(P0.05),PLT在極危重組較其他兩組降低明顯;PLT、APTT在危重組和非危重組之間差異無統(tǒng)計學(xué)意義(P0.017),PT、FIB及D-D在危重組與極危重組之間差異無統(tǒng)計學(xué)意義(P0.017);各組之間MPV比較無統(tǒng)計學(xué)意義(P0.05),差異不明顯。三組患兒PCIS分值比較有統(tǒng)計學(xué)意義(P0.01),極危重組較危重組極非危重組降低明顯;三組間DIC發(fā)生率的比較有統(tǒng)計學(xué)意義(P0.017),可看出隨著病情加重重癥肺炎患兒發(fā)生DIC的概率增大。5.各凝血指標(biāo)與PCIS的相關(guān)性分析,結(jié)果示PLT與PCIS評分相關(guān)性分析r=0.365,P0.05,有輕度相關(guān)性呈正相關(guān)。FIB、FDP及D-D與PCIS評分相關(guān)性分析r分別為-0.585、-0.435及-0.46,P0.05,均有中度相關(guān)性呈負(fù)相關(guān)。結(jié)論:1.重癥肺炎患兒檢查的凝血指標(biāo)PLT、PT、APTT、FIB、FDP及D-D多存在異常改變,且變化方向不完全一致,表明重癥肺炎患兒存在不同程度凝血功能障礙。2.重癥肺炎患兒PCIS評分越低并發(fā)DIC的概率越大,PLT、FIB、FDP及D-D與PCIS存在相關(guān)性,表明凝血功能紊亂程度同患兒病情嚴(yán)重程度具有相關(guān)性。3.PLT、FIB、FDP及D-D等實驗室指標(biāo)結(jié)合PCIS評分分度能更有效判斷重癥肺炎患兒病情及凝血功能狀態(tài),以期早期識別患兒危重程度進(jìn)行早期干預(yù)。
[Abstract]:Objective to summarize the changes and characteristics of coagulation indexes in children with severe pneumonia by detecting the common indexes that can reflect coagulation function in children with severe pneumonia, and to evaluate the coagulation status of children with severe pneumonia. At the same time, the correlation between coagulation indexes and critical case score (PCIS) in evaluating the condition of children with severe pneumonia was analyzed in order to provide theoretical basis for early identification of critical children and timely intervention. Methods the children with pneumonia hospitalized in the affiliated Hospital of Yan'an University from October 2015 to October 2016 were randomly divided into common pneumonia group (n = 30) and severe pneumonia group (n = 30). At the same time, healthy children with general condition matching were selected as control group to detect coagulation series (including PT,APTT,FIB,FDP,D-D) and platelet parameters (including PLT,MPV). The selected children with severe pneumonia were divided into extremely dangerous recombination (鈮，

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