血小板计数及其时相变化对危重病患者预后的预测价值  

Thrombocytopenia and its time course for evaluating prognosis in critically ill patients

作　　者：王晓红[1] 柳明[1] 马少林[1] 曹相原[1] 

机构地区：[1]宁夏医学院附属医院ICU科,宁夏银川750004

出　　处：《中国急救医学》2003年第12期866-868,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的　探讨血小板减少症及其动态变化对危重病预后判断的价值。方法　将危重病患者按血小板是否低于10 0× 10 9/L分为血小板减少组和非血小板减少组 ,按随访结果再分为存活组和死亡组 ,所有患者记录入ICU 2 4h内APACHEⅡ评分、住ICU天数、机械通气时间和入ICU当天、3、5、7、10d血小板计数。结果　①血小板减少组APACHEⅡ评分、机械通气时间及住院死亡率均高于非血小板减少组 (P 均 <0 0 1) ,住ICU天数两组无差异。②以住院死亡率为因变量的Logistic回归分析显示 ,血小板减少症与危重病死亡率密切相关 (OR =2 5 773;P =0 0 0 0 )。③死亡组血小板各时相点均低于存活组 (P<0 0 5 ) ;存活组血小板于入院第 3天短暂下降后持续上升 (P均 <0 0 1) ;死亡组血小板呈持续下降 ,1周后保持稳定 (P <0 0 5或P <0 0 1)。结论　血小板减少症可独立预测危重病预后 ,尤其是血小板的动态变化预测价值更强。ObjectiveTo explore the value of thrombocytopenia and its time course in evaluating prognosis in critically ill patients.MethodsThe critically ill patients were divided into thrombocytopenic group(defined by a platelet count<100×10 9/L)and non-thrombocytopenic group,and survivor group and non-survivor group according to the results of following up.Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score,duration of ICU stay,duration of mechanical ventilation and platelet count after hospitalization,3,5,7 days were recorded.Results①Thrombocytopenic patients had higher APACHE Ⅱ scores at admission,longer mechanical ventilation time and higher hospital mortality than non-thrombocytopenic patients (all P<0.01),but there was no difference in ICU stay days between the two groups.②Logistic regression analysis with hospital mortality was as dependent variable,the occurrence of thrombocytopenia was still significantly related with hospital mortality of critically ill patients (OR=25.773,P=0.000).③The platelet count was lower in nonsurvivors than in the survivors throughout the ICU course( all P<0.05).The platelet count in survivors decreased significantly on the third day after admission,and continued to rise(all P<0.01).In the nonsurvivors,the platelet count decreased continuously after admission,and kept stably by the end of the first week(P<0.05 or P<0.01).ConclusionThrombocytopenia,as an independent risk factor,can predict outcome for ICU patients,especially dynamic changes in platelet count has more predictive value.

关 键 词：危重病 血小板减少症 预后 预测价值 诊断 血小板计数 时相变化 

分 类 号：R446.11[医药卫生—诊断学]