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目的:探究连续性血液净化对小儿脓毒症患者血清抗凝血酶Ⅲ、IL-6及D-二聚体水平的影响。方法:收集我院收治的小儿脓毒症患儿48例,根据随机对照表分为对照组和试验组,每组各24例。两组均实施常规对症治疗,对照组患者予以低分子肝素钙治疗,试验组试验组在对照组的基础上采用床旁血滤机进行连续性血液净化治疗。治疗结束后,对比分析两组患儿临床疗效、血凝四项、T细胞亚群、抗凝血酶Ⅲ、白介素-6、D-二聚体水平以及不良反应的发生情况。结果:治疗后,与对照组相比,试验组的临床总有效率较高(P<0.05);两组血清活化部分凝血活酶时间、凝血酶原时间、凝血时间、血清白介素6及D-二聚体水平下降(P<0.05),纤维蛋白原、抗凝血酶Ⅲ、CD_3~+、CD_4~+、CD_8~+、CD_4~+/CD_8~+水平升高(P<0.05);与对照组相比,试验组血清活化部分凝血活酶时间、凝血酶原时间、凝血时间、血清白介素6及D-二聚体水平较低(P<0.05),纤维蛋白原、抗凝血酶Ⅲ、CD_3~+、CD_4~+、CD_8~+、CD_4~+/CD_8~+水平较高(P<0.05);两组组不良反应发生率相比无显著差异(P>0.05)。结论:连续性血液净化对小儿脓毒症的临床疗效显著,可能与上调抗凝血酶Ⅲ,下调血清IL-6及D-二聚体水平有关。
Objective: To investigate the effect of continuous blood purification on serum antithrombin Ⅲ, IL-6 and D-dimer levels in pediatric sepsis patients. Methods: Forty-eight children with sepsis were collected from our hospital. According to the randomized control table, they were divided into control group and experimental group, 24 cases in each group. Both groups were given conventional symptomatic treatment, patients in the control group were treated with low molecular weight heparin, the experimental group in the control group on the basis of the control group with continuous blood purification treatment. After treatment, the clinical efficacy, four items of blood coagulation, T-cell subsets, antithrombin Ⅲ, interleukin-6, D-dimer levels and adverse reactions were compared between the two groups. Results: Compared with the control group, the total clinical effective rate of the experimental group was significantly higher (P <0.05) after treatment. The serum levels of activated partial thromboplastin time, prothrombin time, clotting time, serum interleukin 6 and D- (P <0.05). The levels of fibrinogen, antithrombin Ⅲ, CD_3 ~ +, CD_4 ~ +, CD_8 ~ + and CD_4 ~ + / CD_8 ~ Compared with the control group, serum activated partial thromboplastin time, prothrombin time, clotting time, serum interleukin 6 and D-dimer levels were lower (P <0.05), fibrinogen, antithrombin Ⅲ , CD_3 ~ +, CD_4 ~ +, CD_8 ~ +, CD_4 ~ + / CD_8 ~ + were higher (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P> 0.05). Conclusion: The clinical curative effect of continuous blood purification on pediatric sepsis is significant, which may be related to the up-regulation of antithrombin Ⅲ, down-regulation of serum IL-6 and D-dimer.