Bentz A I, Palmer J E, Dallap B L, Wilkins P A, Boston R C
Department of Clinical Studies, University of Pennsylvania, Philadelphia, PA, USA.
J Vet Intern Med. 2009 Jan-Feb;23(1):161-7. doi: 10.1111/j.1939-1676.2008.0229.x.
Coagulopathy is a potentially underrecognized complication of sepsis and septic shock in critically ill neonatal foals.
Critically ill neonatal foals have abnormalities in coagulation that are associated with disease severity and outcome.
Foals <72 hours old admitted to a neonatal intensive care unit.
Prospective, observational study. Blood was collected at admission, 24, and 48 hours for platelet count, prothrombin time, activated partial thromboplastin time, antithrombin activity and concentrations of fibrin degradation products, and fibrinogen in plasma from all foals.
Sixty-three foals were enrolled and classified as Septic Shock (12), Septic (28), and Other (23). At least 1 abnormal value was found in 18/28 (64%) samples from the Septic Shock group, 66/85 (78%) from the Septic group, and 30/59 (51%) from the Other group (P= .01). Coagulopathy (3 or more abnormal values) was present in 7/28 (25%) samples in the Septic Shock group, 14/85 (16%) samples in the Septic group, and 3/59 (5%) samples in the Other group (P= .0028). Clinically detectable bleeding occurred in 8/12 (67%) Septic Shock cases, 11/28 (39%) Septic cases, and 3/23 (13%) Other cases (P= .009). Foals in Septic Shock were 12.7 times more likely to have clinical evidence of bleeding than those in the Other group (95% CI 2.3-70, P= .004). Treatment with fluids or plasma did not have a detectable effect on coagulation values.
Coagulopathy commonly occurs in critically ill neonatal foals, especially those with sepsis and septic shock.
凝血功能障碍是危重新生马驹败血症和感染性休克潜在未被充分认识的并发症。
危重新生马驹存在凝血异常，且与疾病严重程度和预后相关。
入住新生儿重症监护病房的72小时龄以内的马驹。
前瞻性观察研究。对所有马驹在入院时、24小时和48小时采集血液，检测血小板计数、凝血酶原时间、活化部分凝血活酶时间、抗凝血酶活性以及血浆中纤维蛋白降解产物和纤维蛋白原的浓度。
纳入63匹马驹，分为感染性休克组（12匹）、败血症组（28匹）和其他组（23匹）。感染性休克组28份样本中有18份（64%）至少有1项异常值，败血症组85份样本中有66份（78%），其他组59份样本中有30份（51%）（P = 0.01）。凝血功能障碍（3项或更多异常值）在感染性休克组28份样本中有7份（25%），败血症组85份样本中有14份（16%），其他组59份样本中有3份（5%）（P = 0.0028）。临床上可检测到的出血在12例感染性休克病例中有8例（67%），28例败血症病例中有11例（39%），23例其他病例中有3例（13%）（P = 0.009）。感染性休克的马驹出现出血临床证据的可能性是其他组马驹的12.7倍（95%可信区间2.3 - 70，P = 0.004）。液体或血浆治疗对凝血值无明显影响。
凝血功能障碍常见于危重新生马驹，尤其是患有败血症和感染性休克的马驹。
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