“5.17”爆炸事件中大面积烧伤伤员检测D-二聚体的临床意义
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摘要
[目的]探讨"5.17"爆炸事件中大面积烧伤伤员检测D-二聚体的临床意义。[方法]以"5.17"爆炸事件中9例大面积烧伤伤员为研究对象,入院后第1天、第2天、第3天、第7天、第10天、第14天抽取外周静脉血,采用免疫比浊法测定D-二聚体水平。同时动态进行APACHEⅡ评分,记录伤员休克期是否平稳度过,是否并发弥漫性血管内凝血(DIC)、脓毒血症,有无发生多器官功能障碍综合征(MODS)以及存活或死亡等临床转归情况。以同期13例小面积烧伤伤员和15例健康体检者作为对照。[结果]大面积烧伤组伤后第1天、第2天、第3天、第7天、第10天、第14天的D-二聚体水平显著高于小面积烧伤组与健康对照组(P<0.05)。9例大面积烧伤员中,D-二聚体水平基本随烧伤面积和APACHEⅡ评分的增加而升高,D-二聚体水平越高,伤员休克期越不平稳,越容易并发脓毒血症与DIC,死亡危险越大。[结论]D-二聚体是大面积烧伤后严重感染并发症和预后的有效预测指标。
[Objective]To investigate the clinical significance of detecting D-two dimer in patients with extensive burns in May 17 explosion.[Methods]Peripheral venous blood samples were taken from 9 patients with extensive burns in May 17 explosion on the 1 st, 2 nd, 3 rd, 7 th, 10 th and 14 th day after admission. The levels of D-dimer were measured by immunoturbidimetry. At the same time, APACHE II score was dynamically used to record whether the shock period was smooth, whether diffuse intravascular coagulation(DIC), sepsis, multiple organ dysfunction syndrome(MODS), survival or death and other clinical outcomes. In the same period, 13 patients with small area burn and 15 healthy persons were used as controls.[Results]The levels of D-dimer on the 1 st, 2 nd, 3 rd, 7 th, 10 th and 14 th day were significantly higher in large area burn group than in small area burn group and healthy control group(P<0.05). D-dimer level increased with the increase of burn area and APACHE II score. The higher the D-dimer level, the more unstable the shock stage, the more easily sepsis and DIC, the greater the risk of death.[Conclusion]D-two dimer is an effective predictor of serious infection complications and prognosis after extensive burn.
[Objective]To investigate the clinical significance of detecting D-two dimer in patients with extensive burns in May 17 explosion.[Methods]Peripheral venous blood samples were taken from 9 patients with extensive burns in May 17 explosion on the 1 st, 2 nd, 3 rd, 7 th, 10 th and 14 th day after admission. The levels of D-dimer were measured by immunoturbidimetry. At the same time, APACHE II score was dynamically used to record whether the shock period was smooth, whether diffuse intravascular coagulation(DIC), sepsis, multiple organ dysfunction syndrome(MODS), survival or death and other clinical outcomes. In the same period, 13 patients with small area burn and 15 healthy persons were used as controls.[Results]The levels of D-dimer on the 1 st, 2 nd, 3 rd, 7 th, 10 th and 14 th day were significantly higher in large area burn group than in small area burn group and healthy control group(P<0.05). D-dimer level increased with the increase of burn area and APACHE II score. The higher the D-dimer level, the more unstable the shock stage, the more easily sepsis and DIC, the greater the risk of death.[Conclusion]D-two dimer is an effective predictor of serious infection complications and prognosis after extensive burn.
引文
[1] 谢桂扬,罗坚村,周文涛.血浆脑钠肽检测在烧伤伤员病情评估中的应用价值[J].检验医学与临床,2016,139(12):1643-1645.
[2] 林莎,祁晓婷,毛卫林,等.血浆D-二聚体及凝血指标在肝硬化、肝癌伤员中的应用价值[J].实验与检验医学,2011,29(3):279-280.
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[5] Bates S M.D-dimer assays in diagnosis and management of thrombotic and bleeding disorders[J].Seminars in Thrombosis & Hemostasis,2012,38(7):673-682.
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[7] 陈卫平,杨慧,蔡爱玲,等.严重烧伤伤员血清前白蛋白、C反应蛋白及其比值的变化[J].海南医学院学报,2015,21(1):86-88.
[8] 唐丽群,彭娜,潘志国,等.血必净注射液对严重脓毒症伤员凝血指标及预后的影响[J].中国中西医结合急救杂志,2012,19(3):132-136.
[9] 张娙,董静莲,王书亮.降钙素原与D-二聚体在评估急诊脓毒症伤员病情及预后的研究[J].中华医院感染学杂志,2015,25(1):11-13.
[10] 占志刚,李春盛.D-二聚体对急诊脓毒症伤员预后价值的前瞻性研究[J].中华危重病急救医学,2012,24(3):135-139.
[11] 李艳,曹锋生,祝伟,等.和肽素和凝血功能监测在重型脑外伤病情评估和预后判断中的作用[J].内科急危重症杂志,2017,24(2):139-141.
[2] 林莎,祁晓婷,毛卫林,等.血浆D-二聚体及凝血指标在肝硬化、肝癌伤员中的应用价值[J].实验与检验医学,2011,29(3):279-280.
[3] 王书杰.弥散性血管内凝血诊治进展[J].中国实用内科杂志,2017,37(2):91-95.
[4] 周静,孙家瑜,孙加冠,等.五种D-二聚体检测方法用于排除可疑静脉血栓栓塞症的临床评价[J].四川大学学报(医学版),2009,40(6):1078-1081.
[5] Bates S M.D-dimer assays in diagnosis and management of thrombotic and bleeding disorders[J].Seminars in Thrombosis & Hemostasis,2012,38(7):673-682.
[6] 刘泽世,呼瑞,刘二军,等.高压电烧伤对SD大鼠血栓调节蛋白、蛋白C、蛋白S及D二聚体的早期影响[J].实用医学杂志,2016,32(1):37-40.
[7] 陈卫平,杨慧,蔡爱玲,等.严重烧伤伤员血清前白蛋白、C反应蛋白及其比值的变化[J].海南医学院学报,2015,21(1):86-88.
[8] 唐丽群,彭娜,潘志国,等.血必净注射液对严重脓毒症伤员凝血指标及预后的影响[J].中国中西医结合急救杂志,2012,19(3):132-136.
[9] 张娙,董静莲,王书亮.降钙素原与D-二聚体在评估急诊脓毒症伤员病情及预后的研究[J].中华医院感染学杂志,2015,25(1):11-13.
[10] 占志刚,李春盛.D-二聚体对急诊脓毒症伤员预后价值的前瞻性研究[J].中华危重病急救医学,2012,24(3):135-139.
[11] 李艳,曹锋生,祝伟,等.和肽素和凝血功能监测在重型脑外伤病情评估和预后判断中的作用[J].内科急危重症杂志,2017,24(2):139-141.