口底蜂窝织炎合并弥散性血管内凝血(DIC)与否的治疗策略对比分析

摘要

Objective:To investigate the clinical characteristics and treatment strategies of Cellulitis of the floor of the mouth complicating disseminated intravascular coagulation(DIC).Methods:Total 26 Cellulitis of the floor of the mouth patients in our department from June 2009 to June 2015 were divided in two groups base on whether complicating DIC.Patients were retrospectively analyzed about the examine index and treatment procedure.Results:(1)There were no statistical significance in the age,gender com position,neutrophil (P＞0.05).(2)The index on admission such as D-dimer 9.73±3.97μg/mL vs.3.20±1.61 μg/mL,(P＜0.05),prothrombintime(PT) 18.95±3.06) s vs.11.01±l.15s,(P＜0.05),fibrinogen (Fbg) 5.95 ± 1.64g/L vs.2.70±0.54g/L,(P＜0.05),activated partial thromboplastin time (APTT) 57.2± 10.48s vs.38.34± 4.26s,(P＜0.05),Line number of endotracheal intubation 7/4 vs.2/13,(P＜0.05),Line number of blood hemofiltration 5/6 vs.0/15,(P＜0.05),death toll 3/8 vs.0/15,(P＜0.05),average length of stay 23.45 ±15.66 vs.12.20 ±3.87,(P＜0.05) were significantly higher in Cellulitis of the floor of the mouth complicating DIC group than the group not complicating DIC.(3) The count of WBC 9.93±2.71％ vs.14.09±3.31％,(P＜0.05) of Cellulitis of the floor of the mouth complicating DIC on admission was significantly lower than the group not complicating DIC.Conclusions:All the patients with DIC were in a critical condition,serious bleeding could be with Improper treatment.These patients should be diagnosed by coagulation indexes and clinical symptoms.For the patients complicating DIC,On the premise of correct DIC,first step is unobstructed airway,the second step is emergency treatment of systemic poisoning and improving minicirculation.Local lesion should be dealt with after systemic symptoms stable.%目的:探讨口底蜂窝织炎合并DiC(disseminated intravascular coagulation)治疗策略.方法:将我科于2009年6月至2015年6月间收入的26例口底蜂窝织炎患者分为合并DIC组与未合并DIC组,回顾性分析患者的检查指标及治疗经过.结果:(1)2组患者在年龄、性别构成比例、中性粒细胞值方面差异均无统计学意义(P＞0.05).(2)口底蜂窝织炎合并DIC组入院时血浆D-二聚体9.73±3.97μg/mL vs.3.20±1.61 μg/mL,(P＜0.05)、血浆凝血酶原时间18.95±3.06s vs.11.01±1.15s,(P＜0.05)、纤维蛋白原5.95±1.64g/L vs.2.70±0.54g/L,(P＜0.05)、活化部分凝血活酶时间57.2±10.48s vs.38.34±4.26s,(P＜0.05)、行紧及气管插管人数7/4 vs.2/13s,(P＜0.05)、行床旁血滤人数5/6 vs.0/15,(P＜0.05)、死亡人数3/8 vs.0/15,(P＜0.05)、平均住院日23.45±15.66 vs.12.20±3.87,(P＜0.05)数值均高于未合并DIC组.(3)口底蜂窝织炎合并DIC入院处理不当时白细胞计数9.93±2.71％ vs.14.09±3.31％,(P＜0.05)低于未合并DIC组.结论:口底蜂窝织炎合并DIC患者病情危重,处理不当有严重出血可能,需结合凝血指标及临床症状明确诊断,对于确实合并DIC者,在纠正DIC的前提下先行通畅气道,紧急治疗全身中毒,改善微循环,局部病灶应视情况于全身症状稳定后再行处理.