脓毒症休克相关性血小板减低症相关探究

发布时间：2018-08-24 07:17

【摘要】：目的:脓毒症是急危重症领域常见的重要课题,此类病人常存在血小板减低的情况,严重者包括脓毒症休克的患者甚至会出现出凝血障碍及血小板计数极低的情况,进而需要包括输血制品在内的升血小板相关治疗。然而,在输血的同时,除了纠正出凝血的障碍,也会同时伴随着并发症、不良反应等情况的出现。但至今并未有明确文献提示在脓毒症休克伴有血小板减低的患者进行输血治疗是否对死亡率、生存率的有影响。本次研究,我们着重探讨对于脓毒症休克相关的血小板减低症患者影响预后的相关因素。方法:收集2015年5月至2017年5月北京市协和医院EICU(急诊科重症监护病房)的脓毒症休克合并血小板减少症并符合筛选标准的35例患者进行回顾分析,记录患者治疗情况,根据出室转归分为死亡组、存活组。观察入室第一次血小板计数、最低血小板计数,各项凝血因子、血细胞计数、出凝血情况的变化及血液制品的使用情况进行分析。比较两组初始及治疗后的各项参数的变化。通过使用SPSS计算t检验、Pearson相关性分析比较死亡组、存活组的各类指标的差异性及组内数据的相关性,并且按照血小板减低程度将患者分为重度减低组、轻度减低组,在验证差异性、相关性的同时,通过计算两组数据的卡方检验来验证输入血小板的治疗意义。结果:1.整体的脓毒症休克伴有血小板减低症的患者总体上看死亡率、存活率与白细胞、红细胞、血红蛋白、血小板及其相关参数指标、凝血指标、输入血小板、出血情况无明确差异性。(P0.05)2.在脓毒症休克的患者出现严重的血小板减低时,死亡率和生存率与入室血小板计数、是否输血小板、PCT(血小板压积)存在明显差异性。(P0.05)3.在重度血小板减低的感染性休克患者中,患者的死亡或存活的转归与入室血小板、输血小板治疗、PCT(血小板压积)有相关性。(P0.05)而住ICU时间和治疗过程中的出血事件的发生于以上各类指标及输血治疗均无明显相关性。(P0.05)4.在重度血小板减低的感染性休克患者中,输入血小板与死亡率有明显相关性。(P0.05)结论:血小板轻度减低的程度对于单纯感染性休克的患者没有预后提示的意义,但是重度血小板减低时,治疗过程中出现的最低的血小板的数值对于死亡有预示意义。对于任意血小板减低程度的患者PCT都有预后提示意义。2.输入血小板并不能改善住ICU时间和出血情况。但是可能对于重度血小板减低的感染性休克患者改善存活率、降低死亡率存在积极意义。
[Abstract]:Objective: sepsis is a common and important subject in the field of acute and critical diseases. Thrombocytopenia is common in such patients, including septic shock patients who may even develop clotting disorders and extremely low platelet count. In turn, the need for blood transfusion products, including the associated treatment of platelet. However, blood transfusion is accompanied by complications and adverse reactions in addition to correcting clotting disorders. However, there is no clear literature on whether transfusion therapy in septic shock patients with thrombocytopenia has an effect on mortality and survival rate. In this study, we focused on prognostic factors in septic shock-associated thrombocytopenia. Methods: from May 2015 to May 2017, 35 patients with septic shock complicated with thrombocytopenia in EICU (Emergency Department of intensive Care Unit) of Peking Union Hospital were collected and analyzed retrospectively. The patients were divided into death group and survival group according to their outcome. The changes of the first platelet count, the lowest platelet count, the coagulation factors, the blood cell count, the coagulation and the use of blood products were observed and analyzed. The changes of parameters were compared between the two groups after initial and after treatment. By using SPSS calculation t test Pearson correlation analysis was used to compare the difference of various indexes and the correlation of data in the death group and the survival group. According to the degree of thrombocytopenia, the patients were divided into two groups: the severe group and the mild group. At the same time, the significance of platelet transfusion was verified by calculating two groups of data by chi-square test. The result is 1: 1. The overall mortality rate, survival rate, leukocyte, red blood cell, hemoglobin, platelet and its related parameters, coagulation index, platelet transfusion, and so on, in patients with septic shock accompanied by thrombocytopenia, Bleeding situation has no clear difference. (P0.05) 2. When severe thrombocytopenia occurred in patients with septic shock, the mortality and survival rate were significantly different from that of platelet count and platelet transfusion (PCT). (P0.05) 3. In septic shock patients with severe thrombocytopenia, the outcome of death or survival in patients with severe thrombocytopenia is associated with platelet entry. There was no significant correlation between the duration of ICU and the bleeding events in the course of treatment and blood transfusion therapy. (P0.05) 4. In severe thrombocytopenia patients with septic shock, there was a significant correlation between platelet transfusion and mortality. (P0.05) conclusion: the degree of mild thrombocytopenia has no prognostic significance in patients with simple septic shock. But in severe thrombocytopenia, the lowest platelet count during treatment is a predictor of death. PCT has prognostic significance. 2. 2 for patients with any degree of thrombocytopenia. Platelet infusion does not improve ICU duration and bleeding. But it may be positive for the patients with severe thrombocytopenia in septic shock to improve survival rate and reduce mortality.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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