Effect of thrombelastography on the assessment of sepsis severity and septic shock with disseminated intravascular coagulation condition in children / 中华实用儿科临床杂志

ABSTRACT

Objective To explore the effect of thrombelastography in sepsis and septic shock with disseminated intravascular coagulation (DIC) condition in children.Methods Ninety-one cases of children admitted to the Pediatric Intensive Care Unit,Zhengzhou Children's Hospital between January 2013 and December 2016 were enrolled in this study.Fifty-eight cases of sepsis,17 cases of severe sepsis and 16 cases of septic shock (including 7 cases DIC and 9 cases non-DIC) were included in 91 cases of children.After admission,they were given conventional treatment according to their condition of illness,such as expansion of rehydration,applying vascular active drags,anti-infection,mechanical ventilation,maintaining internal environment,nutrition support,etc.Thrombelastography of all the patients were detected for 6 hours after admission.The test indexes included blood coagulation reaction time (R),blood clot formation time (K) and blood clot formation rate (alpha),maximum width (MA),coagulation index (CI),etc.And pediatric critical illness scores(PCIS) were also evaluated for 6 hours after admission.Results With the progression of sepsis severity,R value,K value increased dramatically (F =3.629,4.237,all P ＜ 0.05),alpha angle,MA value,CI value decreased (F =32.631,19.938,10.849,all P ＜ 0.05);R value,K value and PCIS scores showed a significant positive correlation (r =0.591,0.827,all P ＜ 0.05),alpha angle,MA value,CI and PCIS scores showed a significant negative correlation (r =-0.793,-0.827,-0.839,all P ＜ 0.05).R and K values in DIC group were significantly greater than the values of non-DIC group (t =4.381,2.613,all P ＜ 0.05),alpha angle was less than that of DIC group obviously (t =5.627,P ＜ 0.05).In DIC group MA and CI levels were significantly less than those of non-DIC group (t =5.416,2.951,all P ＜ 0.05).R value,K value,alpha Angle,MA,CI levels between the dead and surviving patients in the septic shock group had no significant difference (all P ＞ 0.05).Conclusions TEG has a great significance in evaluating severity of children with sepsis.It can also guide clinical assessment in children with septic shock DIC so as to give accurate effective intervention and improve the rescue success rate and the prognosis.