严重多发伤并发继发性血小板增多症的临床分析  

A retrospective analysis of severe multiple trauma with secondary thrombocytosis

作　　者：鲁力[1] 胡平[1] 文玉明[1] 马渝[1] 

机构地区：[1]重庆市急救医疗中心重症医学科,重庆400014

出　　处：《中华急诊医学杂志》2015年第5期493-497,共5页Chinese Journal of Emergency Medicine

基　　金：重庆市临床重点专科建设项目

摘　　要：目的 总结分析严重多发伤并发继发性血小板增多症的发病特征及对预后的影响,探讨适宜的干预措施.方法 回顾性分析重庆市急救医疗中心创伤数据库中2010年3月至2013年3月共680例存活超过72 h的严重多发伤患者临床资料.总结严重多发伤并发继发性血小板增多症（血小板计数＞450×109 L-1）的发病率、时间特征及相关因素,分析其对严重多发伤患者总住院病死率、总住院时间及血栓栓塞事件（包括静脉血栓栓塞事件和动脉血栓栓塞事件）等预后指标的影响.计量资料间比较采用t检验或秩和检验,百分数或率的比较采用x2检验或Fisher精确检验.结果 本组严重多发伤并发继发性血小板增多症的发病率为14.56％,血小板计数中位数为584×109 L-1（最低478×109 L-1,最高1 072×109 L-1）;血小板增多均发生在病程1周以后,中位时间点为第27天（最早8d,最晚304 d）,持续时间（18.62±4.38）d.继发性血小板增多组的脾切除比例、使用血管活性药物超过48 h、使用刺激骨髓造血药物及7d后预防性抗凝治疗比例显著高于血小板正常组（14.14％ vs.7.06％,P=0.03;62.63％ vs.39.07％,P＜0.01; 28.28％vs.6.71％,P＜0.01;90.91％ vs.19.45％,P＜0.01）.血小板增多组患者血小板增多期间最高血浆D-二聚体（mg/L）显著高于血小板正常组患者1周后的最高水平[（11.68±11.90） vs.（5.05±5.11）,P=0.004].两组的总住院病死率（8.08％ vs.8.78％,P=0.82）、总住院时间[34 d（28.5,54.5）d vs.45 d（23,67）d,P=0.41]、总血栓栓塞事件（10.10％ vs.10.50％,P=0.91）及静脉血栓栓塞事件（7.07％ vs.7.92％,P=0.77）差异无统计学意义;血小板增多患者动脉血栓栓塞事件有增多趋势（4.04％ vs.3.10％,P=0.62）,但差异无统计学意义.结论 严重多发伤并发继发性血小板增多症的发生率较高.创伤后脾切除、较长时间使用血管活性药物及使用刺激骨髓造血药物等因�Objective To estimate the clinic features of severe multiple trauma with secondary thrombocytosis as a factor influencing the prognosis.Methods A retrospective single-center study was carried out in 680 patients with severe multiple trauma survived longer than 72 hours in Chongqing Emergency Medical Center from March 2010 through March 2013.The variables including age,gender,ISS （injury severity score）,APACHE Ⅱ score,splenectomy and the usages of vasopressors,blood products transfusion,hematopoietic medicines and anticoagulant were analyzed.The prognosis indices including total in-hospital mortality after 72 hours,length of hospital stay and morbidity of thrombo-embolism were explored.The clinic characteristics and prognosis of severe multiple trauma with secondary thrombocytosis （platelet count more than 450 × 109 L-1） were evaluated.T test or rank sum test was used for comparison between measurement data and Chi-square test or Fisher＇ s exact test was used for comparison between enumeration data.Results Thrombocytosis was identified in 99 （14.56％） patients and it occurred one week after injury with median time of 27 days （ranged from 8 days to 304 days）,and maintained for （18.62±4.38） d.The median of platelet count was 584 × 109 L-1 （lowest 478 × 109 L-1,highest 1 072 × 109 L-1） in severe multiple trauma patients with thrombocytosis.The proportions of splenectomy,prolonged use of vasopressors and employment of hematopoietic medicines or anticoagulant were significantly higher in patients with thrombocytosis than those in patients without thrombocytosis （14.14％ vs.7.06％,P=0.03;62.63％ vs.39.07％,P＜0.01; 28.28％ vs.6.71％,P＜0.01; 90.91％ vs.19.45％,P＜ 0.01）.The highest D-Dimer level presenting in patients with thrombocytosis during the time of platelet increasing was significantly more common than that in patients of non-thrombocytosis group 7 days after trauma [（11.68 ± 11.90） vs.（5.05 ± 5.11）,P =0.004].However,the mortality,length of hospital stay

关 键 词：多发伤 血小板增多 血栓栓塞 抗凝治疗 预后 

分 类 号：R641[医药卫生—外科学] R558.3[医药卫生—临床医学]