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目的:了解晚发型维生素K缺乏性颅内出血患儿治疗前后血浆脱-γ-羧基凝血酶原(DCP)、凝血指标及血清抗利尿激素(ADH)、电解质水平的变化及临床意义。方法:抽取48例晚发型维生素K缺乏性颅内出血患儿,依临床表征分为清醒组、浅昏迷组及深昏迷组。在入院后2 h内及入院第3天清晨采集静脉血测定DCP、凝血指标、ADH及电解质水平。另选28例健康儿童为对照组进行比较分析。结果:治疗前,48例患儿DCP、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、ADH水平随疾病的发展呈渐进升高趋势,与正常组比较差异有统计学意义(P<0.05);Na+、Cl-、Mg2+、Ca2+水平则呈渐进降低趋势,与正常组比较差异有统计学意义(P<0.05)。两组纤维蛋白原(Fib)及K+水平比较差异无统计学意义(P>0.05)。治疗后,各组DCP无明显变化;清醒组其余各项指标均恢复到正常水平;与治疗前比较,浅昏迷组PT、APTT明显缩短(P<0.05),Na+水平明显升高(P<0.05),ADH水平虽明显降低但仍高于对照组(P<0.05),Mg2+明显升高,但仍低于对照组(P<0.05);深昏迷组APTT、Mg2+治疗前后比较差异无统计学意义(P>0.05),PT缩短但仍显著高于对照组(P<0.05),Na+水平有所回升,但仍低于对照组(P<0.05),ADH水平略有下降,但仍显著高于对照组(P<0.05)。结论:DCP是晚发型维生素K缺乏性颅内出血患儿的有效诊断及病情评估指标,而监测PT、APTT、ADH及电解质浓度的变化则对疗效评估有指导意义。
Objective: To investigate the changes and clinical significance of plasma de-γ-carboxy prothrombin (DCP), coagulation index, serum anti-diuretic hormone (ADH) and electrolytes in children with late-onset vitamin K deficiency intracranial hemorrhage before and after treatment. Methods: 48 cases of children with late onset vitamin K deficiency intracranial hemorrhage were divided into conscious group, shallow coma group and deep coma group according to clinical manifestations. Venous blood was collected within 2 h after admission and on the third day of admission to measure DCP, coagulation index, ADH and electrolyte level. Another 28 healthy children as a control group for comparative analysis. Results: Before treatment, the DCP, PT, APTT and ADH levels in 48 children were gradually increased with the development of the disease, with significant difference compared with the normal group (P <0.05). The levels of Na +, Cl-, Mg2 + and Ca2 + showed a gradual decreasing trend, which was significantly different from the normal group (P <0.05). There was no significant difference between the two groups in fibrinogen (Fib) and K + levels (P> 0.05). After treatment, there was no significant change of DCP in each group; the rest of the indicators in the awake group returned to normal levels. Compared with those before treatment, PT and APTT were significantly shortened (P <0.05) and Na + (P <0.05). The level of ADH was significantly lower than that of the control group (P <0.05), and the level of Mg2 + was significantly higher than that of the control group (P <0.05). There was no significant difference between the APTT and Mg2 + groups (P <0.05). PT was also shortened but still significantly higher than that of the control group (P <0.05). Na + level was increased but still lower than that of the control group (P <0.05). ADH level was slightly decreased, Control group (P <0.05). CONCLUSION: DCP is an effective diagnostic and disease evaluation index for children with late-onset vitamin K deficiency. Monitoring changes of PT, APTT, ADH and electrolyte concentration is of guiding significance in evaluating the curative effect.