全身炎症反应综合征新生儿的凝血功能研究

目的　探讨全身炎症反应综合征 (SIRS)新生儿凝血功能的变化及其临床意义。方法　符合SIRS诊断标准的新生儿 12 6例 ,在入院后 2 4h内进行新生儿危重病例评分 ,并采血测定凝血酶原时间 (PT)、凝血酶时间 (TT)、部分活化凝血活酶时间 (APTT)、D 二聚体 (DD)含量和血小板 (PLT)计数。分别以SIRS符合项数及预后、疾病严重程度分组 ,观察其与凝血功能紊乱间的关系。结果　随着SIRS符合项数的增加 ,SIRS新生儿中危重病例所占百分比及病死率明显增高 ,PT、TT、APTT、DD也增高 ,具有明显的相关性。存活组与死亡组间PT、TT、APTT差异无显著性意义 (P >0 0 5 ) ,死亡组DD显著高于存活组 (P <0 0 1)。危重症组PT、TT、APTT、DD与非危重症组比较 ,差异均具显著性意义 (P<0 0 1)。结论　SIRS新生儿存在凝血机制的活化 ,符合SIRS诊断标准项数越多 ,病情越重 ,凝血功能紊乱越显著 ,病死率越高。

Study of coagulation function in newborn infants with systemic inflammatory response syndrome

Objective To study the changes of coagulation function and its clinical significance in newborn infants with systemic inflammatory response syndrome (SIRS).Methods A total of 126 newborn infants diagnosed as SIRS were scored within the 24 hours after the admission according to the criteria of the critical-score-system for neonatal acute severity.In the meantime,their prothrombin time (PT),thrombin time (TT),activated partial thromboplastic time (APTT) and the D-Dimer (DD) levels and platelet counts (PLT) were determined.The patients were divided into the group A(having 2 SIRS entry critria items),group B (having 3 items) and group C (having 4 items) according to the 4 items of clinical criteria for diagnosis of SIRS. These patients were also divided into critical group and non-critical group according to the critical-score-system for neonatal acute severity,or survival group and nonsurvival group according to the prognosis.Their coagulation function were compared.Results The percentage of critical cases and mortality rate in SIRS newborns increased with increasing items of criteria for diagnosis of SIRS,so did the PT,TT,APTT and DD levels.The PT,TT,APTT and DD levels remarkably correlated with the items.There was no difference in the PT,TT,APTT between the survival group and nonsurvival group (P>0.05),while plasma levels of DD in nonsurvival group was significantly higher than that in survival group (P<0.01).The PT,TT, APTT and DD levels in critical group was higher than that in non-critical group (P<0.01).Conclusion There was an activation of the coagulation system in the newborn infants with SIRS.The more items of the diagnostic criteria for SIRS,the patients had the more severe and much remarkable the coagulation disturbance and much higher the mortality.