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目的:探讨动态监测D-Dime、动脉血乳酸、纤维蛋白原、氧合指数在小儿脓毒血症的临床意义。方法:将该院2007年4月～2010年4月重症监护室收治的小儿脓毒血症患儿48例作为观察对象,根据预后最终生存34例设立为生存组,死亡14例设立为死亡组。所有患者入ICU后,常规检测凝血五项、动脉血气分析和动脉乳酸值(LA),计算动脉血气氧合指数(PaO2/FiO2)。采用贝克曼DXC800全自动生化仪进行测试取桡动脉血进行血乳酸测定。纤维蛋白原(FBG)的检测:0.109mmoL/L枸橼酸钠抗凝试管取血3mL,Sysmex CA-1500凝血分析仪进行分析。以免疫比浊法测定D-二聚体(DD)。结果:与治疗前相比较,生存组患者PaO2/FiO2治疗后24 h、治疗后48 h、治疗后72 h得到明显改善,且改善效果明显优于死亡组(P<0.05),而生存组的动脉血乳酸随着治疗时间延长分别与治疗前比较呈逐渐下降趋势(P<0.05),而死亡组随着治疗时间的延长逐渐升高。本组病例治疗前DD死亡组较生存组明显增加,差异有统计学意义(P<0.05)。治疗后,随着治疗时间的延长,生存组DD治疗后24h、治疗后48h、治疗后72 h逐渐下降,且生存组下降水平明显优于死亡组(P<0.05)。而纤维蛋白原同DD正好相反。结论:动态监测D-Dime、动脉血乳酸、纤维蛋白原、氧合指数在小儿脓毒血症具有重要的临床意义,可以反映疾病的预后及严重程度。
Objective: To investigate the clinical significance of dynamic monitoring of D-Dime, arterial lactate, fibrinogen, oxygenation index in pediatric sepsis. Methods: Forty-eight children with pediatric sepsis admitted to ICU from April 2007 to April 2010 in our hospital were enrolled in this study. According to prognosis, 34 patients survived, and 14 patients died. . After all the patients were admitted to the ICU, five items of coagulation, arterial blood gas analysis and arterial lactate (LA) were routinely measured. PaO2 / FiO2 was calculated. Using Beckman DXC800 automatic biochemical analyzer for radial blood test for blood lactate determination. Detection of fibrinogen (FBG): 0.109mmoL / L sodium citrate anticoagulant tube blood 3mL, Sysmex CA-1500 coagulation analyzer for analysis. D-dimer (DD) was measured by immunoturbidimetry. Results: Compared with the pretreatment group, the patients in the survival group improved significantly at 24 h, 48 h after treatment and 72 h after treatment, and the improvement effect was significantly better than that of the death group (P <0.05) Arterial lactate decreased gradually with the time of treatment (P <0.05), and the death group increased gradually with the prolongation of treatment time. This group of patients before treatment DD death group was significantly increased compared with the survival group, the difference was statistically significant (P <0.05). After treatment, with the extension of treatment time, DD in survival group decreased gradually after treatment for 24 h, 48 h after treatment and 72 h after treatment, and the decrease in survival group was significantly better than that in death group (P <0.05). While fibrinogen is just the opposite of DD. Conclusion: Dynamic monitoring of D-Dime, arterial lactate, fibrinogen, oxygenation index in pediatric sepsis has important clinical significance, can reflect the prognosis and severity of the disease.