劉斌　劉善利　崔偉華　趙令強(qiáng)　陳加峰

[摘要] 目的 分析血栓彈力圖在兒童膿毒癥診治中的臨床療效。 方法 方便選取2017年6月—2018年6月期間該院收治的61例膿毒癥患兒作為實(shí)驗(yàn)對象，依據(jù)結(jié)合顯性DIC 評分結(jié)果將其分為試驗(yàn)1組（DIC評分≥5分，n=31）、試驗(yàn)2組（DIC評分<5分，n=30），同期選取30名健康體檢者作為對照組，3組研究對象均開展常規(guī)凝血功能及TEG檢測，對比分析3組研究對象的凝血功能指標(biāo)、TEG指標(biāo)及TEG指標(biāo)診斷試驗(yàn)指標(biāo)。 結(jié)果 凝血功能指標(biāo)：對比試驗(yàn)2組和對照組，試驗(yàn)1組患兒的 PLT（86.25±42.56）×109/L降低，PT（17.54±3.72）s、APTT（40.25±7.42）s升高，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）;對比對照組，試驗(yàn)2組的PLT差異無統(tǒng)計(jì)學(xué)意義（P>0.05），PT、APTT、FBG升高（P<0.05）。TEG指標(biāo)：對比對照組，試驗(yàn)1組患兒的R時(shí)間（7.45±1.62）min、K 時(shí)間（3.43±1.02）min升高，α角（3.41±1.02）°、MA值（54.58±6.43）mm及CI值（-2.56±1.93）降低，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。對比對照組，試驗(yàn)2組患兒的K時(shí)間降低，α角、MA值及CI值升高，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）;TEG指標(biāo)診斷試驗(yàn)指標(biāo)的敏感度、特異度、陽性預(yù)測值及陰性預(yù)測值均較高。 結(jié)論 血栓彈力圖可全面、準(zhǔn)確地分析膿毒癥患兒自身的凝血情況，同時(shí)與DIC評分具有明顯的 相關(guān)性，血栓彈力圖監(jiān)測可對評價(jià)膿毒癥患兒的嚴(yán)重程度、凝血狀態(tài)， 血栓及出血的發(fā)生風(fēng)險(xiǎn)，進(jìn)而指導(dǎo)臨床展開治療，臨床借鑒價(jià)值高。

[關(guān)鍵詞] 血栓彈力圖;兒童膿毒癥;診治;臨床療效

[中圖分類號] R720.597? ? ? ? ? [文獻(xiàn)標(biāo)識碼] A? ? ? ? ? [文章編號] 1674-0742（2019）05（c）-0021-03

[Abstract] Objective To analyze the clinical efficacy of thromboelastography in the diagnosis and treatment of children with sepsis. Methods 61 children with sepsis admitted to our hospital from June 2017 to June 2018 were convenient selected and enrolled in the study. According to the results of combined dominant DIC score， they were divided into test group 1 （DIC score ≥ 5 points， n= 31）， test 2 group （DIC score <5 points， n=30）， 30 healthy subjects were selected as the control group in the same period， and the three groups of subjects all performed routine coagulation function and TEG test， and compared the blood coagulation of the three groups. Functional indicators， TEG indicators and TEG indicators diagnostic test indicators were compared. Results Coagulation function index： in the comparison of test group 2 and the control group， the PLT （86.25±42.56）×109/L decreased， and the PT （17.54±3.72）s and APTT （40.25±7.42）s increased. Statistically significant （P<0.05）; compared with the control group， there was no significant difference in PLT between the two groups（P>0.05）， PT， APTT， FBG increased（P<0.05）. TEG index： Compared with the control group， the R time（7.45±1.62） min， K time （3.43±1.02） min， and α angle （3.41±1.02）° were increased in the test group. The MA value （54.58±6.43） mm and the CI value （-2.56±1.93） decreased， and the difference was statistically significant （P<0.05）. Compared with the control group， the K time of the two groups decreased， the angles of α， MA and CI increased， the difference was statistically significant （P<0.05）; the sensitivity， specificity and positive prediction of the diagnostic indicators of TEG index value and the negative predictive value are higher. Conclusion The thromboelastogram can comprehensively and accurately analyze the coagulation status of children with sepsis and has a significant correlation with the DIC score. The thromboelastogram monitoring can evaluate the severity of the children with sepsis， coagulation status， and thrombosis. And the risk of bleeding， and then guide the clinical treatment， the clinical reference value is high.