输注血小板治疗对成人脓毒症患者预后的影响  

Impact of platelet transfusion on the prognosis of patients with sepsis: a propensity score matching analysis

作　　者：王巧红 陈星星 朱为民 甘慧玲[1] 许仙仙 卞兵兵 李萍[1] 杨鹏[1] 单仁飞[1] 蒋永泼 WANG Qiaohong;CHEN Xingxing;ZHU Weimin;GAN Huiling;XU Xianxian;BIAN Bingbing;LI Ping;YANG Peng;SHAN Renfei;JIANG Yongpo(Department of Emergency,Taizhou Hospital of Zhejiang Province,Taizhou,Zhejiang 318050,China)

机构地区：[1]浙江省台州医院急诊科,浙江台州318050

出　　处：《中华全科医学》2025年第2期235-238,339,共5页Chinese Journal of General Practice

基　　金：浙江省医药卫生研究基金项目(2022KY435);台州市科技计划项目(23ywa47)。

摘　　要：目的 血小板减少是脓毒症患者常见并发症之一。输注血小板常用于增加血小板计数,但对脓毒症诱导的血小板减少症患者的临床影响尚不清楚。本研究旨在探讨输注血小板治疗对脓毒症患者预后的影响。方法 选择2019年1月—2021年12月入住台州医院ICU的脓毒症患者为研究对象。根据有无输注血小板治疗,将患者分为输注血小板组(PT组)和未输注血小板组(NPT组)。采用1∶1倾向性评分匹配法以减少组间不平衡。利用Cox回归模型及Kaplan-Meier生存分析法,分析输注血小板治疗对脓毒症患者预后的影响。结果 共纳入274例脓毒症患者,其中57例患者接受输注血小板治疗,成功匹配了38对患者纳入分析。PT组与NPT组28 d死亡率[31.6%(12/38)vs. 36.8%(14/38),P>0.05]和90 d死亡率[36.8%(14/38)vs. 39.5%(15/38)]比较差异均无统计学意义(P>0.05)。Kaplan-Meier生存分析发现PT组与NPT组患者的28 d和90 d累积生存率比较差异也无统计学意义(P>0.05)。多因素Cox回归分析显示,APACHEⅡ评分是脓毒症患者28 d预后的影响因素(HR=1.138,95%CI:1.066~1.215,P<0.05),输注血小板治疗不是脓毒症患者28 d预后的影响因素(HR=0.457,95%CI:0.182~1.146,P>0.05)。结论 本研究结果显示APACHEⅡ评分是脓毒症患者28 d死亡的独立影响因子,而输注血小板治疗不能改善脓毒症患者的预后。Objective Thrombocytopenia is one of the common complications in patients with sepsis.Platelet transfusions are frequently administered to increase platelet counts,however,their clinical impacts in sepsis-induced thrombocytopenia remains unclear.This article discusses the impact of platelet transfusion on the prognosis of patients with sepsis.Methods Patients with sepsis admitted to the ICU of Taizhou Hospital from January 2019 to December 2021 were selected as the study subjects.According to the platelet transfusion at ICU admission,septic patients were divided into two groups:a platelet transfusion group(PT group)and a non-platelet transfusion group(NPT group).Propensity score matching(PSM 1∶1)was used to balance the groups.Cox logistic regression model and Kaplan-Meier survival analysis were used to analyze the impact of platelet transfusion on the prognosis in patients with sepsis.Results A total of 274 patients with sepsis were included in the study,with 57 patients in the platelet transfusion group.After PSM,38 patients were matched in each group.The primary outcomes were 28-day and 90-day mortalities,which were 31.6%(12/38)and 36.8%(14/38)in the PT group,respectively,compared to 36.8%(14/38)and 39.5%(15/38)in the NPT group,with no significant difference(P>0.05).Kaplan-Meier survival analysis showed no significant difference in the 28-day and 90-day cumulative survival rates of patients between the platelet transfusion group and the NPT group(P>0.05).The Cox logistic regression model showed the APACHEⅡscore(HR=1.138,95%CI:1.066-1.215,P<0.05)as an independent factor influencing prognosis in sepsis patients,while platelet transfusion(HR=0.457,95%CI:0.182-1.146,P>0.05)was not a significant factor.Conclusion This study found that the APACHEⅡscore is an independent factor for 28-day mortality in septic patients,while platelet transfusion does not improve the prognosis of patients with sepsis.

关 键 词：脓毒症 血小板减少症 输注血小板治疗 预后 

分 类 号：R631[医药卫生—外科学] R457.1[医药卫生—临床医学]