低分子肝素治疗新生儿脓毒症并弥散性血管内凝血的疗效

目的探讨低分子肝素治疗新生儿脓毒症并DIC的疗效。方法将本院收治的56例脓毒症并DIC的新生儿随机分成对照组和试验组,每组28例。除常规基础治疗外,对照组采用普通肝素治疗,试验组则采用低分子肝素治疗。观察2组临床疗效及其治疗前后DIC指标水平的变化情况。结果试验组肝素使用时间[(3.0±0.5)d]、出血停止时间[(1.3±0.2)d]、DIC指标恢复正常时间[(3.8±0.2)d]均显著短于对照组[(6.4±0.7)d、(4.5±0.3)d、(6.2±0.5)d](t=4.28、5.81、2.76,Pa<0.05),试验组出血加重例数(5例)显著少于对照组(0例)(χ2=2.32,P<0.05);2组治疗前后的DIC指标水平变化比较差异均有统计学意义(Pa<0.05)。结论采用低分子肝素治疗新生儿脓毒症并DIC的效果显著。     

小剂量肝素早期应用在小儿弥散性血管内凝血治疗中价值的探讨

弥散性血管内凝血是多种疾病处于危重状态的一个病理学环节,以微循环障碍,广泛出血及全身脏器功能衰竭为主要临床表现,病情凶险,病死率高.如果治疗不及时或不正确,则可导致多脏器功能不全综合征(MODS),本文对近年来应用普通肝素治疗的50例DIC病例作一回顾性分析,探讨小剂量普通肝素在DIC早期治疗中的价值.     

弥散性血管内凝血的研究进展

弥散性血管内凝血（DIC）是一种获得必出血综合征，发生在许多疾病的病理过程中，研究发现多种细胞因子释放、生理抗凝固子缺乏及纤维蛋白溶解受抑制等在DIC发病机制中起重要作用。一些新的实验室检查项目以及较敏感或特异指标的测定对DIC的诊断提供了更加可靠的依据，随着对该病发病机制的认识，抗凝血酶Ⅲ、蛋白C浓缩剂、在子抑制剂等新药不断产生，并在临床试用，有些取得了良好的效果。     

危重患儿凝血功能障碍及弥散性血管内凝血临床分析

目的了解危重患儿凝血功能障碍及弥散性血管内凝血(DIC)患病率及病死率,总结DIC诊断及临床应用肝素预防和治疗的体会。方法对所有PICU住院患儿进行小儿危重评分或美国PICU入出院指南评估及凝血功能监测,确诊DIC者根据临床出血情况应用不同剂量肝素。凝血功能障碍者应用小剂量肝素。结果PICU危重患儿病死率为8.6%。凝血功能异常发生率28.6%,病死率25.7%。其中DIC发生率10.6%,病死率45.2%。凝血功能障碍发生率18.0%,病死率14.1%。原发病为脓毒症者73.8%。在DIC早、中期阶段,使用肝素200～240U/(kg·d),有较好疗效。凝血功能障碍者应用肝素60～120/(kg·d),极少发展为DIC。结论DIC是导致危重患儿死亡的重要原因之一,其主要病因是严重感染性疾病。早期合理应用肝素治疗有效,晚期治疗非常困难。小剂量肝素用于危重患儿可能具有预防DIC的作用。     

新生儿弥散性血管内凝血早期诊治探讨(附28例临床分析)

对２８例新生儿ＤＩＣ的诊治经验进行总结，认为早期诊断和及时治疗是提高治愈率的关键。要达到早期诊断，凡遇可以诱发新生儿ＤＩＣ的基础疾病时，一定要密切观察有无ＤＩＣ的临床表现，及时进行必要的实验室检查，明显高凝者可边抗凝边等侯实验结果，以达到早期诊治。文中还介绍新生儿ＤＩＣ使用肝素时的监测方法。     

新生儿弥散性血管内凝血血小板生成素水平的变化

目的了解新生儿弥散性血管内凝血(DIC)急性期及恢复期血小板(PLT)及血小板生成素(TPO)水平的变化,为TPO在新生儿疾病中的临床应用提供依据。方法对30例DIC新生儿及35例足月健康新生儿采用血细胞分析仪检测PLT、血小板比积(PCT)、血小板平均体积(MPV);采用放射免疫法检测新生儿DIC急性期、恢复期及对照组的TPO水平。结果新生儿DIC急性期PLT(75±20)×109/L,MPV(6.0±1.5)fL,PCT(0.14±0.06)%,TPO(280±55)pg/L,与正常对照组比较有显著性差异。恢复期PLT(140±50)×109/L,MPV(8.5±0.5)fL,PCT(0.20±0.04)%,TPO(180±45)pg/L,与急性期比较PLT、MPV、PCT升高,TPO下降,差异显著,但与正常对照组比较亦有显著性差异,仍未完全恢复正常。结论新生儿DIC TPO显著升高,短期内不能恢复正常,与PLT破坏及造血功能不良有关。     

弥散性血管内凝血的研究进展

弥散性血管内凝血是一种获得性的临床综合征，发生在许多疾病的病理过程中。由于DIC发病机理比较复杂，诊断和治疗尚有一定困难。本文仅就DIC的发病机理、实验室检查和治疗方面的研究进展，作一扼要综述。     

Efficiency of heparin in the treatment of newborn infants with respiratory distress syndrome and disseminated intravascular coagulation

Forty newborns with severe shock and disseminated intravascular coagulation were randomized for treatment with heparin or placebo. Mortality was equal in both groups. The heparin group required significantly shorter periods of artificial ventilation. The coagulation system improved faster, and the coagulation pattern showed normal values in the treatment group. Due to the low number of cases, these differences could not be statistically confirmed.With support of the Ministerium für Wissenschaft und Forschung des Landes Nordrhein-Westfalen, Federal Republic of GermanyPresented in part at the 5th Symposium for Pediatric Intensive Care, 7th to 8th April 1978 in Düsseldorf, West Germany     

Anticoagulant therapy by continuous heparin-abtithrombin III infusion in newborns with disseminated intravascular coagulation

In ten newborns with severe alteration of the coagulation system due to DIC, AT III concentrate was infused continuously after prior activation with heparin. The rise in AT III activity showed a great variability among the infants and for one child during the course of the therapy. The mean rise of AT III activity by 40 U/kg per day heparin was 8.7%. If AT III concentrate (40 U/kg per day) was activated with 200 U/kg per day heparin, excessive anticoagulatory effect was only observed in one child. In four children who had failed to respond to prior heparin therapy, improvement of the coagulation status was achieved within 2 days.Abbreviations DIC disseminated intravascular coagulation - AT III antithrombin III     

新生儿败血症合并早期弥散性血管内凝血相关因素的临床研究

目的 探讨新生儿败血症合并早期弥散性血管内凝血(DIC)的相关临床因素,为临床早期诊断新生儿败血症合并DIC 提供参考。方法 采用临床回顾研究方法对我院NICU 2012~2013 年确诊为新生儿败血症的100 例患儿进行研究。根据ISTH 显性DIC 评分系统将患儿分为凝血功能正常组、非显性DIC 组(早期DIC 组)及显性DIC 组(晚期DIC 组),对各组临床表现及相关临床因素进行统计分析。结果 100 例败血症患儿中合并早期DIC 者44 例(44%);3 组患儿硬肿的发生率差异有统计学意义(χ2=12.776,P<0.05);窒息、出血及G- 菌感染是败血症合并早期DIC 的独立危险因素。结论 对于临床有窒息、出血及G- 菌感染的新生儿应积极监测凝血功能并采取早期干预措施,预防患儿由早期DIC 进展为晚期DIC,降低新生儿败血症的病死率。     

Distinction between fibrinogen and fibrin degradation products produced during disseminated intravascular coagulation in childhood

Fibrin-fibrinogen degradation products in serum from five children with disseminated intravascular coagulation (DIC) were characterized using a method of immunoabsorption followed by SDS-polyacrylamide gel electrophoresis. All of the samples contained not only fragment D-dimer which was produced on plasmin lysis of cross-linked fibrin, but also fibrinogen degradation products (fragments X, Y and D). These results suggest that both fibrinogenolysis and fibrinolysis take place simultaneously in DIC.     

弥漫性血管内凝血患儿血浆D-二聚体的检测及意义

目的研究弥漫性血管内凝血（ＤＩＣ）患儿血浆Ｄ二聚体水平对ＤＩＣ的诊断价值。方法采用双抗体夹心ＥＬＩＳＡ法及乳胶凝集法（Ｌａｔｅｘ）法对４２例ＤＩＣ患儿血浆Ｄ二聚体进行检测,用ｔ检验进行分析。结果ＤＩＣ患儿血浆Ｄ二聚体水平明显高于对照组,差异非常显著（Ｐ＜００１）。结论血浆Ｄ二聚体是诊断ＤＩＣ的早期、特异性指标     

早产儿肺透明膜病多器官组织微血栓栓塞的病理因素研究

目的观察２４小时内死亡的早产儿肺透明膜病（ＨＭＤ）患儿各器官组织中微血栓发生率及组织病理改变；探讨微血栓栓塞的病理因素。方法４８例（Ａ组２８例，Ｂ组２０例）ＨＭＤ尸检后，在生物显微镜下观察肺、心肌、脑、肝、脾、肾、肾上腺、甲状腺、胸腺和胰腺组织切片中微血栓，计算每平方厘米中微血栓数，平均检查每个器官组织面积为５５／ｃｍ２。结果肺及肺外２个以上器官血栓数≥２／ｃｍ２占５８％（２８／４８）；器官组织有栓塞、退行性变、出血和坏死；肺微血管显示微循环障碍、肺动脉高压的病理改变。结论微循环障碍并发ＤＩＣ导致微血栓形成和栓塞是重度ＨＭＤ患儿死于多器官功能障碍的主要病因。     

Incidence of disseminated intravascular coagulation in the course of septicemia in newborn infants

Coagulation studies including platelet count, partial thromboplastin time, prothrombin index, and assays of fibrinogen, prothrombin, proaccelerin, antihemophilic globuline and fibrin (ogen)degradation products were carried out in 12 newborn infants afflicted with septicemia. All patients had a decrease of platelet counts. 8 patients showed characteristic signs of DIC. In 3 cases we found marked consumption and in 3 other cases mild forms of DIC. In 2 cases DIC had occurred a few days before we obtained samples. The remaining 4 patients exhibited as a result of endotoxinemia a low platelet count without affecting blood coagulation. The most reliable laboratory findings for the diagnosis of DIC seem to be reduced platelet counts and low levels of fibrinogen and factor V.

---

Zusammenfassung Bei 12 Neugeborenen mit septischen Infektionen wurden die Thrombocytenzahlen, partielle Thromboplastinzeit, Prothrombinindex, der Fibrinogenspiegel, der Gehalt an Fibrin(ogen)abbauprodukten und die Aktivität von Prothrombin, Proaccelerin und antihämophilem Globulin ermittelt. Erniedrigte Thrombocytenzahlen fanden wir bei allen 12 Patienten. 8 Patienten wiesen charakteristische Zeichen von disseminierter intravasaler Gerinnung (DIC) auf. Bei 3 Patienten fanden wir einen deutlichen Verbrauch und bei 3 anderen Patienten milde Formen von DIC. Bei 2 Fällen hatte DIC wenige Tage vor der Blutentnahme stattgefunden. Die übrigen 4 Patienten entwickelten als Folge der Endotoxinämie Thrombocytopenie ohne Beteiligung des Blutgerinnungssystems. Verläßliche Laboratoriumsergebnisse zur Diagnose von DIC scheinen reduzierte Thrombocytenzahl und niedrige Spiegel von Fibrinogen und Faktor V zu sein.