血小板检测联合APACHEⅡ评分系统对心脏外科重症监护病房患者预后的评估价值分析  

The Value of Platelet Counts in the Prognosis of Prognostic Evaluation of ICU Patients of Cardiac Surgery

作　　者：韩宏光[1] 王辉山[1] 李晓密[1] 徐莉莹[1] 孟庆涛[1] 张晓慧[1] 韩劲松[1] 刘宇[1] 

机构地区：[1]沈阳军区总医院心脏外科,沈阳110016

出　　处：《临床误诊误治》2016年第7期67-70,共4页Clinical Misdiagnosis & Mistherapy

基　　金：中国博士后科学基金资助项目(2013M542568)

摘　　要：目的 探讨血小板检测联合急性生理学和慢性健康状况评定标准Ⅱ（acute physiologic and chronic health evaluationⅡ,APACHEⅡ）对心脏外科重症监护病房（CSICU）患者预后的评估价值。方法 收集2013年12月1日—2014年11月30日沈阳军区总医院CSICU患者2340例,均取术后次日清晨空腹肘静脉血测定血小板计数,并行24 h APACHEⅡ评分测定。根据APACHEⅡ评分分为〈15分、15-24分、25-34分、〉34分组,根据预后分为存活组和死亡组,比较各组血小板水平差异。另根据血小板计数分为血小板正常组与血小板减少组,分析两组APACHEⅡ评分的差异及其二者的相关性。结果 不同APACHEⅡ评分组血小板计数比较,15-24分组〉25-34分组〉25-34分组（P均〈0.05）。APACHEⅡ评分与预计病死率及实际病死率分别呈正相关（r=0.87,P=0.000;r=0.91,P=0.000）。死亡组APACHEⅡ评分显著高于生存组,血小板计数显著低于存活组,差异均有统计学意义（P〈0.01）。血小板减少组APACHEⅡ评分、病死率均显著高于血小板正常组,住CSICU时间长于血小板正常组,差异均有统计学意义（P〈0.05或P〈0.01）。相关性分析显示,患者血小板计数随APACHEⅡ评分的增加而减少,二者呈显著负相关（r=-0.729,P=0.000）。结论 CSICU患者血小板计数与APACHEⅡ评分存在相关性,二者结合可应用于CSICU围术期患者早期病情严重程度及预后评估,可前瞻性指导临床治疗,最大限度提高医疗质量,降低病死率。Objective To investigate the evaluation value of platelet counts and acute physiology and chronic health evaluation Ⅱ （APACHEⅡ ） score on prognosis of patients admitted to Cardiac Surgery Intensive Care Unit. Methods 2340 cases of CSICU were collected in the General Hospital of Shenyang Military Area Command during December 1, 2013 and November 30, 2014. The blood platelet counts were measured in the first postoperative morning fasting venous blood of patients, at the same time APACHE II was scored within 24 hours after admission. The patients were divided into 4 groups： 〈 15 score, 15-24 score, 25-34 score, and 〉 34 score according to APACHE Ⅱ scores. All the patients were divided into two groups based on their prognosis：the survival group and the death group. The platelet levels in each group were analyzed and compared. According to the level of platelet counts, all the patients were divided into normal group and thrombocytopenia group. The relationships between APACHE Ⅱ score and platelet count were analyzed. Results The platelet counts in each group were compared, 15-24 score group 〉 25-34 score group 〉 34 score group 〉 34 score group （ P 〈 0.05 ）. The APACHE Ⅱ score in the death group was significantly higher than that in the survival group, the platelet counts were significantly lower than that in the survival group, and the difference was statistically significant （P 〈 0.01 ）. The APACHE Ⅱ score and mortality rate of the thrombocytopenia group were significantly higher than those of the normal group, and the CSICU time was longer than that of the normal group, and the difference was statistically significant （P 〈 0.05 or P 〈 0.01 ）. Conclusion The level of platelet counts is related to APACHE Ⅱ score of patients admitted to Cardiac Surgery Intensive Care Unit. The combination of the two can be applied in the evaluation of the severity of the early disease in patients with CSICU, and prospective guidance for clinical treatment, and to maximize the quality

关 键 词：心脏外科手术 预后 血小板计数 急性生理学和慢性健康状况评分 

分 类 号：R654.2[医药卫生—外科学]