出血性休克并脑病综合征诊治的探讨.docVIP

出血性休克并脑病综合征诊治的探讨 　　【摘要】 目的：探讨出血性休克与脑病综合征诊断和临床干预措施。方法：回顾性分析9例出血性休克与脑病综合征的临床资料，总结治疗措施及预后。结果：患儿多表现发热（9/9）、腹泻（9/9）、抽搐（8/9），均有不同程度意识改变，部分患儿有出血倾向（4/9），均存在毛细血管渗漏综合征（9/9），血小板计数下降时间为3～11 d，ALT及AST高峰期为5～9 d，CK、LDH峰值在病程5～9 d，CK及LDH升高时间约为病程3～9 d，止凝血功能PT、APTT延长时间为病程3～4 d，血栓弹力图异常（6/6），多数乳酸升高（8/9），治疗以抗休克、抗DIC、脑保护、抗毛细血管渗漏为主，经过抢救除1例死亡、1例有严重神经系统后遗症，6例患儿好转，预后较好。结论：HSES诊疗关健是早期诊断及干预，早期有效循环及呼吸支持可取得较好预后，休克、DIC、毛细血管渗漏综合征（CLS）、脑水肿等多种病理生理学环节参与发病，尽早纠正休克和DIC、脑保护是诊疗关键，血栓弹力图、BNP具有一定临床价值。 　　【关键词】 出血性休克与脑病综合征（HSES）； 休克； DIC； 毛?血管渗漏综合征； 血栓弹力图 　　【Abstract】 Objective：To investigate the diagnosis and clinical intervention of hemorrhagic shock combined with encephalopathy syndrome.Method：The clinical data of 9 cases of hemorrhagic shock combined with encephalopathy were retrospectively analyzed，the treatment and prognosis of patients were observed.Result： Many children with fever（9/9），diarrhea（9/9） and convulsions（8/9），changed the different degrees of consciousness，some patients with bleeding tendency （4/9），there were capillary leak syndrome（9/9），platelet count decreased time for 3-11 d，the peak period of ALT and AST were 5-9 d，CK and LDH peak in the course of 5-9 d，CK and LDH rise time were about the course of 3-9 d，PT and APTT coagulation prolonged duration of 3-4 d，thrombelastogram anomaly（6/6），most of the increase in lactic acid（8/9）.The treatment of anti shock，anti DIC，brain protection，and anti capillary leakage.After emergency treatment of 1 case death，1 case of serious neurological sequelae，6 patients were improved，the prognosis was good.Conclusion：The key of diagnosis and treatment of HSES include early diagnosi and early intervention.Early effective circulation and respiratory support can achieve a better prognosis.Many pathophysiological factors such as shock， DIC，capillary leakage syndrome （CLS） and cerebral edema are involved in the disease.To correct shock and DIC as soon as possible and protect the cerebral tissue is the vital aspect of treatment.Thrombus elastic map and BNP have cert