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Objective:To explore the clinical significance of thrombelastography (TEG) and conventional coagulation tests (CCTs) in the diagnosis of trauma-induced coagulopathy(TIC) and the risk factors for TIC.Methods:Traumatic patients hospitalized in PICU at Shengjing Hospital of China Medical University from December 1, 2017 to January 31, 2019 were divided into three groups according to injury severity score(ISS): non-severe group(≤16 points), severe group (17-25 points) and extremely severe group(>25 points). All patients received 2.5 mL of venous blood at admission/after 6 h, 12 h, 24 h, and 48 h injury to detect TEG and CCTs.The prevalence, time of onset, recovery time of coagulation function and risk factors for TIC were summarized.Results:A total of 64 cases were collected, including 18 non-critical cases, 28 critical cases and 18 extremely critical cases.TEG and CCTs were used to diagnose TIC in nine cases(14.1%)and four cases(6.3%), respectively.TIC could be diagnosed by TEG at 6 hours after trauma, and 12 hours for CCTs.TEG was used to diagnose four cases of hypercoagulability.Univariate analysis showed that female, blood transfusion, transfusion, shock, multiple organ dysfunction syndrome, mechanical ventilation, hypothermia, low age, low glasgow coma scale (GCS) and high ISS were all risk factors for TIC.Logistics regression analysis found that children with high-risk factors such as girl, hypothermia, shock and mechanical ventilation were 4.333, 17.889, 10.208, and 4.479 times more likely to develop TIC than those without high-risk factors.For every 1 score increase in the ISS score, the risk of TIC increased by 1.147.As the age increased by 1 year, GCS increased by 1 point, and the risk of TIC decreased by 0.765 and 0.817, respectively, which were protective factors for TIC.Conclusion:TEG and CCTs are consistent in the diagnosis of TIC, but TEG is more sensitive at an earlier stage and can detect hypercoagulability.Female, shock, hypothermia, low age, high ISS, and low GCS are risk factors for TIC.
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Objective To investigate the development and application of blood purification in PICU. Methods The demographic data,diagnosis,length of stay,prognosis,patterns and frequency of blood purifi-cation and complications of PICU patients treated with blood purification in our hospital from 2010 to 2017 were retrospectively analyzed. Results The patients with blood purification accounted for 3. 1％ of hospital-ized children in the same period. From 2010 to 2017,the patients and times with blood purification increased by 370. 6％ and 398. 3％ respectively. The times of continuous veno-venous hemodiafiltration(CVVHDF), plasma exchange and hemoperfusion increased by 135. 2％,6300％ and 1600％ respectively. The frequency of CVVHDF,plasma exchange and hemoperfusion accounted for 42. 8％(492/1151),33. 5％(386/1151), and 23. 7％ (273/1151) respectively. Drug and toxic poision accounted for the highest proportion of 28. 6％(81/284),neurological diseases accounted for 20. 8％(59/284),sepsis with multiple organ dysfunction syn-drome accounted for 18. 0％( 51/284 ) , digestive system diseases, autoimmune diseases, renal diseases and metabolic diseases accounted for 14. 4％( 41/284 ) ,4. 9％( 14/284 ) ,4. 9％ ( 14/284 ) and 4. 2％( 12/284 ) respectively. The cure rate was 63. 8％. Complication included thrombus. Conclusion Blood purification has become the preferred modality for the management of critically ill children. Pediatric blood purification tech-niques have developed rapidly in our PICU and domestic pediatric. Further specification is required,so that it may represent the adequate choice for critical ill children.
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Objective To evaluate the effects of different energy feeding on the nutritional status, clinical course and outcome of children with congenital heart disease(CHD) in PICU.Methods Forty cases of hospitalized CHD children were selected as research objects from July 1,2016 to February 28,2017.They were randomly divided into two groups,one group(high-calorie milk group,n=20) were fed with high-calo-rie milk and the other(common milk group,n=20)were fed with common milk.The nutritional status of the two groups were calculated by physical measurements, laboratory indicators, nutrition risk screening and resting energy expenditure.This research also calculated the liquid and energy per day,compared their actual feeding situation,assessed their nutritional status and cardiac function at discharge,and compared the hospi-tal stay,preoperative and postoperative mechanical ventilation time and postoperative fever time.Results There was no statistical difference in the assessment of malnutrition during the discharge of high-calorie milk group.In common milk group,the proportion of moderate to severe malnutrition of discharge was significantly higher than that of admission(χ2=2.537,P=0.042).The proportion of moderate to severe malnutrition was great higher in common milk group than that in high-calorie milk group,but there was no statistical difference, and neither in nutritional risk screening nor cardiac function between the two groups at discharge.Albumin and transferrin of high-calorie milk group were significantly higher than those of the common milk group(t =2.195,P=0.034;t=2.064,P=0.046).Also the number of appropriate energy supply and feeding cases in the high-calorie group were higher than those in the common milk group(t=2.334,P=0.025;χ2=10.600,P=0.005).Nine cases underwent cardiopulmonary operation in the two groups respectively.There was no statisti-cal difference in the time of ventilatory support between the two groups before and after operation, but the fever time of high-calorie milk group was significantly lower than that of the common milk group(t=2.439, P=0.027).Conclusion The incidence of malnutrition and undernourishment of children with CHD is high, and the incidence of nutrition risk is high,therefore increasing energy supply of children with CHD without in-creasing the heart load could improve their nutrition status and clinical outcome.