失补偿性慢性肝病和败血症儿童的低凝血性:通过血栓形成显微镜进行评估
Vignesh Vinayagamoorthy1, Anshu Srivastava1, Indranil Das2
1From the Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
JPGN reports
|August 21, 2023
概括
患有非补偿性慢性肝病和感染的儿童往往有异常的凝血,血栓凝血图 (TEG) 识别了低凝血状态并预测了不良结果. 在检测出血风险方面,TEG优于INR和血小板计数.
科学领域:
- 儿科胃肠病学 儿科胃肠病学
- 肝病学 肝病学是一种肝病学.
- 血液学 血液学 血液学
背景情况:
- 儿童脱补偿性慢性肝病 (DCLD) 带来了复杂的挑战,通常因感染而复杂化.
- 凝血异常在DCLD中很常见,可能会被系统性感染加剧.
- 准确评估凝血状况对于管理这些重症儿童至关重要.
研究的目的:
- 评估DCLD和并发感染的儿童的凝血状况,使用血栓形成显微镜 (TEG).
- 确定影响该儿科群体凝血异常的因素.
- 评估TEG参数对出血和患者结果的预测值.
主要方法:
- 对30名患有DCLD和感染的儿童进行前性研究.
- 在入院和治疗后使用国际规范化比率 (INR),血小板计数和TEG (R,K,α角,MA,CI,LY30) 来评估凝血.
- 收集了包括系统性炎症反应综合征 (SIRS),感染严重程度,出血事件和结果在内的临床数据.
主要成果:
- 在入院时,96.7%的患者患有长期的INR,80%的患者患有血小板狭窄症,56.6%的患者通过TEG.
- 在严重的败血症 (81.1%) 和持久性SIRS (100%) 中,低凝血性更频繁.
- 与非出血患者相比,出血患者的R时间延长和MA/α角度减少;R时间≥8.5分钟预测死亡率 (83%的灵敏度,100%的特异性).
结论:
- 超过一半患有DCLD和感染的儿童表现出可通过TEG检测的低凝度.
- 严重的败血症和持续的SIRS显著恶化凝血状态.
- TEG提供了对出血风险的卓越洞察力,并且比传统的凝血测试更有效地预测出血不良结果.
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