危重病患者血小板与血糖变化的临床价值探讨  

Clinical value of changes in platelet and blood glucose in critical ill patients

作　　者：谭勇明[1] 韦赤勇[1] 邓树荣[1] 

机构地区：[1]广西贵港市中西医结合骨科医院,贵港市537100

出　　处：《广西医学》2007年第2期187-189,共3页Guangxi Medical Journal

摘　　要：目的探讨血小板与高血糖及其动态变化对危重病患者预后判断的临床价值。方法回顾性分析我院急救中心176例ICU危重病患者入院第1、3、5、7、10天时间段血常规和血糖的检测结果及APACHEⅡ评分,按是否存在血小板减少分组;根据患者预后,将病例分为生存组和死亡组。结果(1)血小板减少组的APACHEⅡ评分、血糖水平、住院天数、MODS发生率及住院死亡率均明显高于非血小板减少组(P<0.05);(2)生存组入院第1天APACHEⅡ评分和血糖水平均明显低于死亡组(P<0.001),血小板则明显高于死亡组(P<0.001);(3)生存组在入院第1、3、5、7和10天的时间位点上,血小板计数呈持续升高,且明显高于死亡组(P均<0.001);(4)在每个时间位点上,生存组的血糖水平呈持续下降,且明显低于死亡组(P<0.001)。结论血小板和血糖水平能准确、敏感地反映危重病患者的病情和预后,可作为危重病患者的重要临床监测指标;血小板持续降低和血糖持续升高,具有更高的预警价值。Objective To explore the value of thrombocytopenia,hyperglycemia and their time course in evaluating prognosis in critical ill patients. Methods 176 critical ill patients in ICU were divided into thrombocytopenia group and non-thrombocytopenia group according to the platelet count, or survivor group and non-survivor group according the prognosis, retrospectively. Blood routine examination,blood glucose and acute physiology and chronic health evalution Ⅱ （APACHE Ⅱ ）score 3,5,7,10 days after hospitalization were recorded. Results （ 1 ） Thrombocytopenic patients had higher APACHE Ⅱ scores,level of blood glucose, incidence rate of MODS, hospital mortality and longer duration of hospitalization than non-thrombocytopenic patients （ all P 〈 0.05 - 0.001 ） ; （2） APACHE Ⅱ scores and the level of blood glucose at admission in survivor group were significantly lower than those of non-survivor group ,but the platelet count was higher in the survivors than in the nonsurvivors（ P 〈 0. 001 ） ;（ 3 ）The platelet count in survivors increased continuously ,it was higher significantly than in the nonsurvivors （ all P 〈 0. 001 ） ; （ 4 ） In the survivors, the level of blood glucose decreased continuously after admission,it was significantly lower than in the nonsurvivors （P 〈 0.001 ）. Conclusion The platelet count and level of blood glucose are sensitive indicators of poor prognosis and severity of critical ill patients, especially dynamic changes in platelet count and blood glucose have more predictive value.

关 键 词：危重疾病 全身性炎症反应综合征 多器官功能综合征 血小板减少 高血糖 疾病预后 

分 类 号：R059.7[医药卫生]