重症患者血清血小板水平对预后的影响  

The influence of serum platelet level on prognosis in critically ill patients

作　　者：高飞 董亮 杨挺 严洁 郭赟[2] 

机构地区：[1]南京医科大学附属无锡人民医院重症医学科,江苏无锡214023 [2]南京医科大学附属无锡市儿童医院儿呼吸科,江苏无锡214000

出　　处：《中国急救医学》2017年第11期996-999,F0003,共5页Chinese Journal of Critical Care Medicine

基　　金：国家自然科学基金（81400054）;江苏省自然科学基金（BK20140122）;江苏省青年医学重点人才项目（QNRC2016179）

摘　　要：目的探讨重症监护病房（ICU）中重症患者血清血小板（PLT）异常的发生情况及PLT水平对预后的影响。方法前瞻性选择2015—03～2017—03ICU收治的重症患者进行筛选，所有入组患者均在收住ICU24h内留取静脉血，标本送检测血清PLT水平，并记为PLT，按PLT水平进行分组：PLT〈100×10^9／L为低PLT组；100×10^9／L≤PLT≤300×10^9／L为正常PLT组；PLT〉300×10^9／L为高PLT组。统计所有患者的年龄、性别、既往史、主要诊断、机械通气时间、ICU住院时间、28d病死率、序贯器官衰竭评分（SOFA）及急性生理与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分。采用Logistic回归分析筛选重症患者死亡的危险因素；采用Kaplan—Meier生存分析，按PLT水平分层，绘制28d生存曲线，采用Log—rank检验比较低PLT组、高PLT组和正常PLT组的累计生存率。结果①共纳入重症患者330例，其中低PLT组136例、高PIJT组35例和正常PLT组159例。②低PLT组以脓毒症患者多见（37．50％），高PⅡ组以脑梗死患者多见（48．57％），正常组以肺部感染多见（19．50％）。③低PLT组与正常PLT组患者性别、年龄、基础慢性疾病、APACHEⅡ评分比较，差异无统计学意义（P〉0．05），但低PLT组患者SOFA评分（P：0．039）和28d病死率（P=0．033）更高，机械通气时间（P=0．035）和ICU住院时间（P=0．019）也明显更长。④根据多因素Logistic回归分析显示，血清PLT水平（OR=1．327，95％CI=1．113～1．627，P=0．010）和APACHEⅡ评分（OR=1．545，95％CI=1．322～1．806，P=0．000）为影响ICU重症患者28d内死亡的独立危险因素。按照血清PLT水平分层绘制Kaplan—Meier生存曲线，低PLT组28d累计生存率显著低于正常PLT组（P=0．029）。结论血清PTJT水平与ICU中重症患者的病死率密切相关，在临床工作中我们应该重视患者PLY减少的现象。Objective To investigate the prevalence of serum platelet abnormalities in critically ill patients in the intensive care unit （ICU） and the effects of serum platelet levels on the prognosis. Methods A prospective selection of critically ill patients treated at ICU from March 2015 to March 2017 was screened. All the enrolled patients received venous blood within ICU 24 hours of stay, and the specimens were detected serum platelet level, and recorded as PLT. Grouped by PLT level： PLT 〈 100 × 10^9/L for the low PLT group; 100 × 10^9/L〈PLT≤300 × 10^9/L for the normal PLT group; PLT 〉 300 × 10^9/L for the high PLT group. Statistics of all patients＇ age and gender, past history, diagnosis, duration of mechanical ventilation and ICU stay, 28 day mortality, sequential organ failure assessment （SOFA） and acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ ） score. Logistic regression analysis was used to screen the risk factors of death in patients with severe Kaplan - Meier; using survival analysis, stratified by PLT level, rendering the 28 day survival curve, using Log -rank test the cumulative survival rate of low PLT group and high PLT group and normal PLT group. Results①A total of 330 patients with severe diseases, including low PLT group 136 cases, high PLT group 35 cases and normal PLT group 159 cases. ②The patients with low PLT group were more frequent with sepsis （37.50%）. The patients with cerebral infarction were more frequent in the high PLT group （48.57%）, and the lung infection was more common in the normal group （ 19.50% ）. ③Compared with low PLT group and normal PLT group in gender, age, chronic disease, APACHE 11 score, the difference was not statistically significant （ P 〉 0.05 ） ; patients with low PLT showed higher SOFA score （ P = 0.039） and 28 - day mortality （ P = 0. 033 ）, and longer duration of mechanical ventilation （ P = 0. 035 ） and ICU stay （P = 0. 019） were significantly longer. ④According to the multi - factor

关 键 词：重症患者 血小板(PLT) 急性生理与慢性健康状况评分系统II(APACHE II)评分 序贯器官衰竭评分(SOFA) 预后 

分 类 号：R446.11[医药卫生—诊断学]