论文部分内容阅读
目的 观察新生儿宫内细菌感染合并DIC并发微血管病性溶血性贫血 (MHA)外周血的特点和临床特征 ,以及抗凝疗法的用药时机。方法 对确诊宫内细菌感染并发MHA的 2 2例 (早产儿 17例 ,足月小于胎龄儿 5例 ) ,逐日监测外周血象 ,适时做凝血因子消耗试验 ,并检测心肾功能。死亡病例行尸体解剖。结果 14例败血症(致病性大肠杆菌 12例 ,金葡菌 2例 )于生后 (2 4.3± 12 .0 )h并发MHA ,余 8例MHA发生于日龄 (4 .2± 1.4)天 ;外周血显现血小板降低为 (71.79± 17.6 3)× 10 9/L ,血红蛋白进行性下降 (幅度为每天 5 0 10 0g/L) ,网织红细胞、有核红细胞和异形红细胞数升高。临床表现为黄疸加重 [总胆红素 (2 82 .0± 40 .0 ) μmol/L],突发性呼吸困难、微循环障碍和皮肤见出血点及瘀斑。死亡的 15例于皮肤见瘀点时应用肝素 ,组织病理改变表明 ,各器官组织已广泛形成微血栓。治愈的 7例于黄疸加重、呼吸频率突然增快、伴有血红蛋白下降时应用肝素 ,于用药后 1h呼吸困难缓解 ,48hMHA得到控制 ,72h血象恢复正常。结论 新生儿细菌感染合并DIC ,并发血红蛋白进行性下降 ,幼稚红细胞和异形红细胞数升高 ,黄疸加重和突发性呼吸困难 ,提示并发MHA ,及时应用抗凝疗法可降低病死率。
Objective To observe the characteristics and clinical features of neonatal intrauterine bacterial infection combined with DIC complicated with microvascular hemolytic anemia (MHA) peripheral blood and the timing of anticoagulant therapy. Methods Twenty-two cases of MHA complicated with intrauterine infection (17 preterm children and 5 full term infants less than gestational age) were diagnosed by intrauterine infection. Peripheral blood samples were monitored daily for consumption of clotting factor and heart and kidney function. Death cases were performed on autopsy. Results 14 cases of sepsis (pathogenic Escherichia coli and 2 cases of Staphylococcus aureus) were complicated with MHA at postnatal period (2.43 ± 12.0) h, and the remaining 8 cases occurred on day (4.2 ± 1.4) days (71.79 ± 17.6 3) × 10 9 / L in peripheral blood and hemoglobin decreased progressively (amplitude of 5010g / L per day). The number of reticulocytes, nucleated erythrocytes and dystrophic red blood cells increased. Clinical manifestations of jaundice increased [total bilirubin (2 82 .0 ± 40 .0) μmol / L], sudden dyspnea, microcirculation and bleeding see the skin spots and ecchymosis. Heparin was applied to 15 cases of death when seen in the skin. The histopathological changes indicated that microthrombus was formed extensively in various organs and tissues. Healed seven cases of jaundice, respiratory rate suddenly increased, with hemoglobin decline in the application of heparin, 1h after treatment of dyspnea relief, 48hMHA be controlled, 72h blood returned to normal. Conclusions Neonatal bacterial infection combined with DIC, concurrent hemoglobin decreased, the number of erythrocytes and abnormal red blood cells increased, jaundice increased and sudden dyspnea, suggesting concurrent MHA, and timely application of anticoagulant therapy can reduce mortality.