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目的:回顾性分析纤维蛋白原(fibrinogen,FIB)降低(FIB≤1.0 g/L)患儿的临床特点,寻找其可能相关继发因素,为FIB降低的病因、早期治疗及防治重要脏器出血提供参考依据。方法:回顾性分析我院320例住院患儿住院期间血浆FIB降低(FIB≤1.0 g/L)的病例资料,对纤维蛋白原降低程度、出血部位、出血发生率、出血程度、临床合并症、治疗反应等进行分析,用SPSS PASW18.0统计软件分析数据,用卡方检验分别对不同纤维蛋白原降低程度及有无合并其他凝血功能障碍或血小板降低时的出血发生率、出血程度进行分析,用t检验对有无输注冷沉淀前后的纤维蛋白原水平进行分析,以P<0.05判定差异有统计学意义,并根据样本量及统计情况进行P值矫正。结果:320例患儿中男性193例,女性127例;以新生儿多见(165例,51.6%)。其中281例(87.8%)患儿合并了已报道的可能导致FIB降低的继发因素,以肝功能损害(179例,55.9%)最常见;259例(80.9%)合并有其他凝血功能障碍。320例FIB降低病例中,162例(50.6%)为轻度降低;149例(46.6%)发生了不同程度的出血。发生出血的患儿中47%为轻度出血(70/149例),36.9%为重度出血(55/149例),且重度出血也见于FIB轻度降低者。经分析FIB不同降低程度的出血发生率(P=0.149)及出血严重程度(P=0.088)均无统计学差异。而FIB降低合并其他凝血障碍和/或血小板降低时的出血发生率及出血程度有明显升高(P<0.05)。出血可发生于任何部位,以胃肠道出血(71例,47.7%)最多见。出血组与未出血组分别有40.3%与34.5%的病例给予了FIB制品(新鲜冰冻血浆或冷沉淀)的补充,两组输注FIB制品前后FIB变化均有显著差异(P=0.001),提示输注FIB制品有利于FIB的升高。结论:纤维蛋白原降低可能发生不同部位不同程度的出血,即使轻微降低仍可发生严重出血,临床应予以重视,当发现纤维蛋白原降低时,应根据患儿出血倾向综合考虑,及时积极采取合理治疗并随访纤维蛋白原水平。
OBJECTIVE: To retrospectively analyze the clinical features of children with FIB (FIB≤1.0 g / L) reduction and to find out the possible secondary factors that may contribute to the reduction of FIB, early treatment and prevention of major organ hemorrhage Provide a reference basis. Methods: A retrospective analysis of our hospital 320 cases of hospitalized children with reduced FIB plasma FIB (FIB ≤ 1.0 g / L) data on the reduction of fibrinogen, bleeding site, the incidence of bleeding, bleeding, clinical complications, Treatment response and other analysis, SPSS PASW18.0 statistical software analysis of data using the chi-square test were different fibrinogen reduction and the presence or absence of other coagulation disorders or thrombocytopenia when the incidence of bleeding, the degree of bleeding were analyzed, The levels of fibrinogen before and after the infusion of cryoprecipitate were analyzed by t test. The difference was statistically significant at P <0.05, and P value was corrected according to the sample size and statistics. Results: There were 193 males and 127 females in 320 cases, more common in neonates (165 cases, 51.6%). Among 281 cases (87.8%), there were two reported secondary factors that might lead to the decrease of FIB. The most common cause was hepatic impairment (179 cases, 55.9%). Other 259 cases (80.9%) had other coagulation disorders. 162 cases (50.6%) of 320 cases of FIB decreased mildly; 149 cases (46.6%) had different degrees of hemorrhage. Of the children who developed bleeding, 47% were mild bleeding (70/149 cases), 36.9% were severe bleeding (55/149 cases), and severe bleeding was found in mildly reduced FIB. There was no significant difference in the incidence of hemorrhage (P = 0.149) and the severity of bleeding (P = 0.088) after analysis of different degrees of reduction in FIB. However, FIB decreased the incidence of hemorrhage and the degree of bleeding when combined with other coagulopathy and / or thrombocytopenia (P <0.05). Bleeding can occur in any part of the gastrointestinal bleeding (71 cases, 47.7%) the most common. FIB products (fresh frozen plasma or cryoprecipitate) were supplemented in 40.3% and 34.5% of the patients in the bleed group and in the non-bleed group, respectively. There were significant differences in FIB before and after infusion of FIB products (P = 0.001) Infusion FIB products are conducive to the rise of FIB. Conclusions: The decrease of fibrinogen may result in different degrees of hemorrhage in different parts. Severe hemorrhage may occur even with a slight decrease. Clinics should pay attention to it. When fibrinogen is found to be decreased, hemorrhagic tendency of the child should be considered comprehensively and promptly and reasonably Treatment and follow-up of fibrinogen levels.