血小板及骨髓象变化在危重病临床监测中的意义  

Analysis of platelet and bone marrow biopy in the monitoring of critically ill patients

作　　者：陈德昌[1] 李红江[1] 毛居卫[2] 杨兴易[1] 

机构地区：[1]中国人民解放军急救医学中心,第二军医大学长征医院急救科,上海200003 [2]青岛市人民医院ICU

出　　处：《中华急诊医学杂志》2002年第1期40-42,共3页Chinese Journal of Emergency Medicine

摘　　要：目的　研究血小板及骨髓象变化在危重病临床监测中的意义。方法　ICU危重病患者 2 13例 ,入选标准为各种原因所致的SIRS和MODS。回顾性将病例分为死亡组 (n=6 2 ) 和存活组 (n=15 1)。入院后当天及 3、 7、 10d进行APACHEⅡ评分和血小板检查 ,入院后次日对各种体液进行细菌和真菌培养。35例患者在入ICU后 2 4小时内进行骨髓象检查。结果　入ICU时存活组和死亡组APACHEⅡ评分明显增高 ,但差异无显著意义 ;治疗 7d和 10d后 ,存活组下降至 10分以下 ,而死亡组上升至 2 0分以上 (P <0 0 1)。血小板在入院时两组均降低 ,但在治疗 7d和 10d死亡组患者血小板再度进行性下降 ,而存活组上升至正常范围 (P <0 0 0 1)。严重的阴沟杆菌感染、金黄色葡萄球菌感染 (MRA)和真菌性脓毒症 ,血小板低下的发生率分别为 72 3%、 89 6 %和 93 5 %。危重病患者骨髓象显示存活组带状核和分叶核粒细胞、浆细胞、巨核细胞明显高于死亡组 (P <0 0 5 ) ,而淋巴细胞死亡组显著高于存活组 (P <0 0 1)。结论　血小板进行性下降和骨髓抑制能较正确、敏感地反映危重病患者的病情和预后 ,而血小板检查快速、简单易行在临床上更有实用价值。Subjective To study the clinical significance of the changes of platelet and bone marrow biopy in critical illness.Methods In ICU,213 critically ill patients who suffered from SIRS and MODS,were enrolled in this retrospective study and divided into two groups,alive group(n=151)and dead group(n=62).Platelet count and APACHE Ⅱ evaluation were performed immediately after hospitalization and 3,7,and 10 days later.Bacterial and fungal culture in various body fluid were obtained second day after the hospitalization.Bone marrow examination was done in 35 patients within 24 hrs after the hospitalization.Results APACHE Ⅱ evaluation was much higher,but similar in the two groups immediately after the hospitalization.However,it increased markedly in the dead group,and decreased dramatically in the alive group 7 days after therapy.There was a significant difference between the two groups(P<0 01).Platelet was slightly lower in both groups immediately after hospitalization.After three day's therapy,it increased to the normal range in the both groups.However,it progressively dropped in the dead group 7 and 10 days later.There was a significant difference when compared with the alive group(P<0 001).In addition,severe infection caused by Bacillus cloacae,Staphylococcus aureus(MRA),and fungi induced throm bocytopenia easily.Bone marrow examination revealed that the band forms,neutrophils,plasma cells,and megalokaryocyte the alive group were much higher than those in the dead group(P<0 05),whereas lymphocyte in survival group was lower than that in the dead group.Conclusion Refractory thrombocytopenia and arrest of bone marrow are sensitive indicators of poor prognosis and severity of critically ill patients.

关 键 词：血小板 骨髓 全血炎症反应综合征 多器官功能障碍综合征 脓毒症 危重病 监测 

分 类 号：R459.7[医药卫生—急诊医学]