血小板及骨髓象变化与危重病患者预后关系的研究  

Effects of the change s of platelet and bone marrow biopy on the prognosis of critical illness patients

作　　者：张洪[1] 赵施竹[1] 

机构地区：[1]河南省鹤壁市鹤壁煤业集团总医院检验科,458000

出　　处：《中国临床实用医学》2009年第4期73-74,共2页China Clinical Practical Medicine

摘　　要：目的 探讨血小板及骨髓象变化与危重病患者预后的关系。方法将危重病患者按血小板是否减少分为血小板减少组和非血小板减少组，根据患者预后再分为死亡组和生存组，所有患者分别记录入ICU24h内APACHEⅢ评分、多器官功能障碍综合症（MODS）发生率和入ICU1、3、7、14D的血小板计数。血小板减少组中51例行骨髓穿刺涂片检查。结果血小板减少组APACHEⅢ评分、MODS发生率及住院病死率均明显高于非血细胞减少组，但住ICU时间两组比较差异无统计学意义；危重病患者骨髓象显示，生存组巨核细胞数高于死亡组（P〈0．05），同时，生存组杆状核、分叶核细胞和浆细胞数高于死亡组，但淋巴细胞数显著低于死亡组。结论血小板进行性下降和骨髓象抑制能较准确、敏感地反映危重病患者的病情和预后，而血小板检查快速、简单易行，在临床上有实用价值。Objective To study the changes of the platelet and bone marrow and prognosis of patients with critically ill. Methods The patients were divided into thrombocytopenic group and non-thrombocytopenic group according to whether there thrombocytopenia, alive group and dead group according to the prognosis of patients. Platelet count, APACHEⅢ evaluation, the incidence of multiple organ dysfunction syndrome （MODS） were performed immediately after hospitalization（ ICU ） and 3,7, and 14 days later. Bone marrow examination was done in 51 patients within 24 hr. Results APACHEIII score, MODS incidence and mortality were significantly higher in the group of thrombocytopenia than the group of non-thrombocytopenia, but the ICU stay time between the two groups was not significant ; the number of megakaryocyte in bone marrow of patients in the alive group showed higher than those death group （ P 〈 0. 05 ）. At the same time, the number of the nuclear rod-shaped, the sub-leaf cells and plasma cell in the alive group were higher than the death group, but the number of lymphocytes was significantly lower than the death group. Conclusion Platelet decline and bone marrow suppression are sensitive in dicators of poor prognosis and severity of critically ill patients.

关 键 词：血小板 骨髓 多器官功能障碍综合症 急性生理和慢性健康状况评分Ⅲ 

分 类 号：R459.7[医药卫生—急诊医学]