危重症患者血小板变化与病情预后的关系研究(1)
摘要：目的 探讨血小板水平与危重症患者预后的关系。方法 选择危重症患者157例，按急性生理学与慢性健康状况Ⅱ( acute physiology and chronic health evaluation Ⅱ， APACHEⅡ) 评分结果将入选患者分为三组：：A组 (APACHEⅡ评分 < 12分)， B组 (APACHEⅡ评分 12～ 20分) ， C组 (APACHEⅡ评分> 20分 )，根据患者的预后分为存活组和死亡组。进行APACHEⅡ评分及序贯器官衰竭估计(Sequential organ failure assessment ，SOFA)评分，血小板计数做专门记录。结果 A组与B组、C组比较，前者血小板计数较后两组高，SOFA评分低，病死率低，均有统计学差异，B组与C组比较，前者较后者血小板计数高，SOFA评分低，病死率低，有统计学差异；存活组与死亡组比较，APACHEⅡ评分与血小板计数有显著性差异。结论 血小板水平监测对评估危重病患者的病情预后具有一定的临床意义。
关键词：危重症；血小板；急性生理学与慢性健康状况评分；序贯器官衰竭估计评分；预后
Abstract： Objective To investigate the relationship between the platelet level and the prognosis of patients with critically ill. Methods 157 critically ill patients were divided into three groups based on acute physiology and chronic Health Evaluation(APACHE)Ⅱ， that were A group (APACHE score<12)， B group (APACHE score 12～20) and C group (APACHE score>20) . Patients were divided into two groups according to survival or death according to prognosis. APACHEⅡscor and Sequential outraged failure assessment score were measured， and record the platelet counts. Results Group A compared with group B， group C， higher ranges are found in the former than the latter ，SOFA score and the case fatality rate are significantly lower. Group B compared with group C， higher ranges are found in the former than the latter ，SOFA score and the case fatality rate are significantly lower. Survival group compared with death group， APACHE Ⅱ score and the platelet count have significant difference .Conclusion Platelet levels to assess the condition of critical care patients prognosis has certain clinical significance.
Key words：Critically ill；Platelet；APACHE Ⅱ score；SOFA score ；Prognosis
重症监护病房(Intensive care unit ，ICU)的患者病情危重，变化迅速，往往是多系统多脏器功能受损严重，多伴有凝血功能和血小板计数异常。血小板计数减少在危重症患者中更为常见，国外早有报道ICU 患者中血小板减少者住院时间更长，生存率更低[1]。如能及早预测可能出现的异常，并在早期进行有效干预，可降低死亡率，改善预后。本研究采用回顾性研究方法探讨血小板水平与疾病严重程度和预后的关系， 旨在为危重症患者的临床评估提供更多依据。
1资料与方法
1.1 一般资料 选择2013年5月～2014年5月入住我院综合重症监护病房(ICU)患者157例， 其中男 83例，女 74例，年龄(56.45±15.67)岁，原发病为慢性阻塞性肺疾病合并肺部感染 55 例，脑外伤32例，自发性脑出血13例，脑干或者大面积梗死15 例，重症急性胰腺炎10例，严重创伤及大手术后28例，心肺复苏术后4例。 所有病例均于发病或术后24 h内入住，排除血液病、肿瘤、肝病及慢性脏器功能不全等病史并排除服用药物引起血小板计数变化的患者。入选患者随访至出院或死亡。按入住综合ICU后24h 急性生理学与慢性健康状况Ⅱ( acute physiology and chronic health evaluation Ⅱ， APACHEⅡ) 评分结果将入选患者分为三组：：A组 (APACHEⅡ评分 < 12分)， B组 (APACHEⅡ评分 12～20分) ， C组 (APACHEⅡ评分> 20分 )，根据患者的预后分为存活组和死亡组。分组后患者性别、年龄等一般资料具有可比性，P>0.05。
1.2 方法 记录入选患者一般资料，包括性别、年龄、体重等，以及入ICU后24h内的体温、心率、血压、呼吸频率、检测血常规、尿常规、动脉血气分析、肝功能、肾功能、血清离子等生化指标，根据以上资料进行APACHEⅡ评分及序贯器官衰竭估计(Sequential organ failure assessment ，SOFA)评分，血小板计数做专门记录。, 百拇医药(樊桂玲 霍志荣)
关键词：危重症；血小板；急性生理学与慢性健康状况评分；序贯器官衰竭估计评分；预后
Abstract： Objective To investigate the relationship between the platelet level and the prognosis of patients with critically ill. Methods 157 critically ill patients were divided into three groups based on acute physiology and chronic Health Evaluation(APACHE)Ⅱ， that were A group (APACHE score<12)， B group (APACHE score 12～20) and C group (APACHE score>20) . Patients were divided into two groups according to survival or death according to prognosis. APACHEⅡscor and Sequential outraged failure assessment score were measured， and record the platelet counts. Results Group A compared with group B， group C， higher ranges are found in the former than the latter ，SOFA score and the case fatality rate are significantly lower. Group B compared with group C， higher ranges are found in the former than the latter ，SOFA score and the case fatality rate are significantly lower. Survival group compared with death group， APACHE Ⅱ score and the platelet count have significant difference .Conclusion Platelet levels to assess the condition of critical care patients prognosis has certain clinical significance.
Key words：Critically ill；Platelet；APACHE Ⅱ score；SOFA score ；Prognosis
重症监护病房(Intensive care unit ，ICU)的患者病情危重，变化迅速，往往是多系统多脏器功能受损严重，多伴有凝血功能和血小板计数异常。血小板计数减少在危重症患者中更为常见，国外早有报道ICU 患者中血小板减少者住院时间更长，生存率更低[1]。如能及早预测可能出现的异常，并在早期进行有效干预，可降低死亡率，改善预后。本研究采用回顾性研究方法探讨血小板水平与疾病严重程度和预后的关系， 旨在为危重症患者的临床评估提供更多依据。
1资料与方法
1.1 一般资料 选择2013年5月～2014年5月入住我院综合重症监护病房(ICU)患者157例， 其中男 83例，女 74例，年龄(56.45±15.67)岁，原发病为慢性阻塞性肺疾病合并肺部感染 55 例，脑外伤32例，自发性脑出血13例，脑干或者大面积梗死15 例，重症急性胰腺炎10例，严重创伤及大手术后28例，心肺复苏术后4例。 所有病例均于发病或术后24 h内入住，排除血液病、肿瘤、肝病及慢性脏器功能不全等病史并排除服用药物引起血小板计数变化的患者。入选患者随访至出院或死亡。按入住综合ICU后24h 急性生理学与慢性健康状况Ⅱ( acute physiology and chronic health evaluation Ⅱ， APACHEⅡ) 评分结果将入选患者分为三组：：A组 (APACHEⅡ评分 < 12分)， B组 (APACHEⅡ评分 12～20分) ， C组 (APACHEⅡ评分> 20分 )，根据患者的预后分为存活组和死亡组。分组后患者性别、年龄等一般资料具有可比性，P>0.05。
1.2 方法 记录入选患者一般资料，包括性别、年龄、体重等，以及入ICU后24h内的体温、心率、血压、呼吸频率、检测血常规、尿常规、动脉血气分析、肝功能、肾功能、血清离子等生化指标，根据以上资料进行APACHEⅡ评分及序贯器官衰竭估计(Sequential organ failure assessment ，SOFA)评分，血小板计数做专门记录。, 百拇医药(樊桂玲 霍志荣)