严重多发伤并继发性血小板增多症发病特征及其预后分析  

Clicical characteristics and prognosis of thrombocythemia econdary to severe multiple injury

作　　者：郭智勇[1] 曾庆[1] 宋先权[1] 陈怀祥[1] 

机构地区：[1]重庆三峡中心医院公共急救分院急诊科,万州404000

出　　处：《中国急救复苏与灾害医学杂志》2016年第10期982-984,共3页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的探讨严重多发伤并发继发性血小板增多症的发病特征及其预后。方法回顾性分析2014年1月-2015年10月重庆三峡中心医院收治的450例严重多发伤患者临床资料。总结严重多发伤继发性血小板增多症的发病率，对比血小板增多组与正常组患者的ISS评分、入院时APACHEⅡ评分、脾切除等一般情况，比较创伤1周后血小板增多组与正常组D-二聚体最高水平，并比较两组患者的临床事件发生情况。结果本组病例并发继发性血小板增多的发病率为14．67％，血小板计数中位数为579×10^9L；血小板增多均发生于病程1周以后，中位时间点为第28天，持续时间（19．12~5．36）d。继发性血小板增多组的脾切除、使用刺激骨髓造血药物、使用血管活性药物超过48h、7d后预防性抗凝治疗比例均明显高于血小板正常组（P〈0.05）；血小板增多组患者血小板增多期间最高血浆D-二聚体水平明显高于血小板正常组患者1周后的最高水平（P〈0．05）；两组的总住院病死率、总住院时间、总血栓栓塞事件、静脉血栓栓塞事件及动脉血栓栓塞事件的差异均无统计学意义（P〈0．05）。结论严重多发伤并继发性血小板增多症的发生率较高，且血小板增多患者脾切除比例高于血小板正常患者，血管活性药物、抗凝药物及刺激骨髓造血药物的时间使用长于血小板正常患者。Objective To investigste the clicical characteristics and prognosis of thrombocythemia econdary to severe multiple injury. Methods 450 in-patients of severe multiple injuries were divided into 2 groups： secondary thrombocythemia group （n=66） with the platelet level 579×10^9/L 2 times during the course of disease, and normal platelet groupo （n=384） with the platelet leve1≤450× 10^9/L all along. The clinical outcome, incidence of secondary thrombocythemia, thrombotic events, specific treatment, D-Dimer level 1 week after injury were observed. Results The rates of splenectomy and prophylactic anticoagulant therapy, and the utilization rate of vasoactive drugs and hematopoietic drugs by stimulating the bone marrow of the secondary thrombocythemia group were all significantly higher than those of the normal platelet grouip （all P 〈0.05）. The D-Dimer levels during the existance of secondary thrombocythemia group were all significantly higher than that when the platelet level was normal in the same group （all P 〉0.05）, and were all significantly higher than those of the normal platelet group （all P 〉0.05）. There were no significant differences in the total hospitalization time, total hospital mortality, and incidence of thrombotic events between these 2 groups （all P 〉0.05）. Conclusion Unable to cause increase of hospital stay time and mortality, secondary thrombocythemia in the patients with severe injuries may be a benign reaction. Mon!toring og D-Dimer helps observe the risk of throbolism events.

关 键 词：严重多发伤 血小板增多 预后 

分 类 号：R588.3[医药卫生—内分泌]