儿童弥漫性血管内凝血的临床特点及预后分析

Clinical Characteristics and Prognosis Analysis of Children with Diffuse Intravascular Coagulation

目的探讨弥漫性血管内凝血(DIC)患儿的临床表现及实验室指标的特点及其与预后的关系。方法对新疆维吾尔自治区人民医院儿科2009年1月-2014年5月诊断为DIC110例患儿的临床表现及实验室指标进行回顾性分析和总结。结果 110例DIC患儿中原发病为脓毒症80.9%(89/110),肿瘤性疾病占19.1%(21/110)。其中出血发生率9.1%(10/110),MODS发生率70.9%(78/110),休克发生率27.7%(30/110),溶血性贫血发生率0.9%(1/110),实验室指标D-二聚体阳性检出率100%。原发病为脓毒症及肿瘤性疾病的两组DIC患儿,在出血、多器官功能受损、休克、溶血性贫血发生率构成比无统计学差异(P>0.05)。DIC患儿病死率为25.4%(28/110),死亡组在出血、MODS、休克的发生率明显高于存活组(P<0.05)。结论儿童DIC的主要诱因为严重感染性疾病及肿瘤性疾病,早期诊断及积极治疗可减少患儿死亡率。

Objective To explore clinical manifestation and laboratory index of children with disseminated intravascular coagulation and its relationship with prognosis. Methods 110 Children with disseminated intravascular eoagulafionln were collected form January 2009 to May 2014 in department of pediatrics of people＇s hospital of Xinjiang Uygur Autonomous Region. Clinical manifestations and laboratory indexes of them were retrospectively analyzed and summarized. Results In 110 DIC patients, sepsis accounted for 80.8% （89/110）, neoplastic disease accounted for 19.1%（21/110）, including incidence of bleeding accounted for 9.1%（10/110）, MODS rate was 70.9% （78/110 ）, the incidence rate of shock was 27.7% （30/110）, hemolytic anemia rate was 0.9% （1/110）, the positive rate of laboratory parameters D- dimer was 100%. Incidence ratio of bleeding, multiple organ damage, shock and hemolytic anemia had no statistical difference between two groups.The mortality rate of children with DIC was 25.4% （28/110）, incident rate of bleeding, MODS and shock in death group were significantly higher than that of the survival group （P〈0.05）. Conclusion The leading cause of children DIC are severe infectious and tumor diseases, early diagnosis and active treatment can reduce children with DIC mortality rate.