血小板及骨髓象变化对危重病患者预后的影响

Effects of the changes of platelet and bone marrow biopy on the prognosis of critical illness patients

目的探讨血小板及骨髓象变化对危重病患者预后的影响。方法将危重病患者按血小板是否减少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病死组,所有患者分别记录入ICU24 h内APACHEⅡ评分、多器官功能障碍综合征(MODS)发生率和入ICU1、3、5、7、10 d血小板计数。血小板减少组中20例患者行骨髓穿刺涂片检查。结果血小板减少组APACHEⅡ评分、MODS发生率及住院病死率均明显高于非血小板减少组,但住ICU时间两组比较差异无统计学意义;危重病患者骨髓象显示,存活组巨核细胞数高于病死组(P<0.05),同时发现,存活组杆状核、分叶核粒细胞和浆细胞数高于病死组,而淋巴细胞数显著低于病死组。结论血小板进行性下降和骨髓象变化能较正确、敏感地反映危重病患者的病情和预后,而血小板检查快速、简单易行,在临床上更有实用价值。

Objective To study the effect of the changes of platelet and bone marrow binpy on the prognosis of critical illness patients. Methods In ICU, 166 critical illness patients who were divided into thromboeytopenie group （defined by a platelet count 〈 100 × 10^9/L） and non - thrombocytopeuic group according to the number of the platelet, and into survival group and non - survival group according to ttle results of follow - up. The incidence of MODS, Acute Physiology and Chronic Heahh Evaluation Ⅱ （APACHE Ⅱ ） score and platelet count on 1, 3, 5, 7, 10 day after entering ICU were recorded. Bone marrow examination was done in 20 patients of the thrombocytopenic group, who were divided into survival group and non - survival group according to the results of follow - up. Results The platelet count in nonsurvival group was lower than that in survival group throughout the ICU course （ all P 〈 0. 05 ）. At the same time, the platelet count of survivals group continued to rise （ all P 〈 0.05 ） alter a significant de- crease on the 3 day, and the platelet count in nousmwival group decreased continuously. The APACHE Ⅱ scores, the incidence of MODS and the hospital mortality of thromboeytopenic patients were higher than those in non - thrombocytopenic patients. Bone marrow exanfination revealed that the megakaryoeyte count in the survival group were much higher than that in the nonsurvival group （ P 〈 0.05 ） , the band t~）rms, neutrophils and plasma cells in the survival group were much higher than those in the nonsurvival group. Conclusion The refractory thromboeytopenia and the changes of bone marrow biopy are sensitive to patients condition and the prognosis of patients. The cheek of platelet is simple and convenient.