脓毒症患儿凝血功能障碍的评判及预后的回顾性研究

Evaluation of coagulation function disorder and prognosis in children with sepsis:a retrospective study

目的 回顾性分析研究脓毒症凝血功能评判方法及与预后的关系。方法 采用儿童续贯器官功能衰竭评估(pSOFA)回顾性分析2015年7月1日至2020年6月30日该院儿科重症监护病房(PICU)收治的147例脓毒症患儿。用中国弥散性血管内凝血诊断积分系统(CDSS)、脓毒症相关凝血功能障碍(SIC)两种凝血评分方法进行分组和评判,对影响预后的凝血相关因素进行回归分析。结果 存活组与死亡组相比较,血红蛋白(Hb)差值、血小板(PLT)差值、血乳酸(LAC)、凝血功能均有显著差异;CDSS的查准率、查全率和准确率分别是46.2%、54.5%、85.3%,SIC的查准率、查全率和准确率分别是34.4%、100.0%、85.7%。预后影响因素的二元logistic回归分析示Hb差值、PLT差值、凝血酶原时间(PT)、血肌酐(Cr)是影响患儿预后的独立相关因素,随Hb差值、PLT差值、PT增大,死亡风险随其增加(均P<0.05)。ROC曲线分析示,PT、Cr可预测脓毒症患儿预后(均P<0.05)。结论 pSOFA值得临床中使用并完善;CDSS、SIC更有利于提高脓毒症的预警和处理。

Objective To retrospectively analyze and study the evaluation method of coagulation function in sepsis and its relationship with prognosis.Methods A total of 147 children patients with sepsis admitted to PICU of this hospital from July 1,2015 to June 30,2020 were retrospectively analyzed by the pediatric sequential organ failure assessment score(pSOFA).The two coagulation scoring methods of Chinese DIC scoring system(CDSS) and sepsis-induced coagulopathy(SIC) were used to conduct the grouping and evaluation.The coagulation related factors affecting the prognosis conducted the regression analysis.Results There were significant differences in Hb difference value, PLT difference value, lactic acid(LAC) and coagulation function between the survival group and death group;the precision rate, recall rate and accurate rate of CDSS were 46.2%,54.5% and 85.3% respectively, which of SIC were 34.4%,100.0% and 85.7% respectively.The binary logistic regression analysis of prognostic influencing factors showed that Hb difference value, PLT difference value, PT and Cr were the independent related factors affecting the prognosis, suggesting that Hb, PLT and PT were the protective factors.The receiver operating characteristic(ROC) curve analysis showed that Pt and Cr could predict the prognosis of children patients with sepsis(all P<0.05).Conclusion pSOFA is worthy of clinical use and improvement.CDSS and SIC are more beneficial to increase the early warning and treatment of sepsis.