血小板计数的动态变化对危重烧伤患者病情和预后的判断价值

Dynamic changes of platelet count in assessing the severity and prognosis of critically burned patients

目的研究危重(重度、特重度)烧伤患者血小板计数的动态变化,及其对病情严重程度和预后的判断价值。方法以安徽医科大学第一附属医院烧伤科2007年至2010年收治的131例危重烧伤患者作为研究对象,并按有无发生全身炎症反应综合征(SIRS)分为SIRS组和非SIRS组,SIRS组按入院后存活情况分为SIRS生存组和SIRS死亡组。测定入院第1、4、7、10、14天血小板计数的动态变化,同时记录患者入院后24h内急性生理与慢性状况评分Ⅱ(APACHEⅡ)。结果各组血小板计数于入院第4天短暂下降后持续上升,入院第4、7、10、14天,非SIRS组血小板计数均显著高于SIRS组(均P<0.05),SIRS生存组血小板计数于各时相点均显著高于SIRS死亡组(P<0.05)。非SIRS组APACHEⅡ评分显著低于SIRS组(P<0.05),SIRS生存组APACHEⅡ评分显著低于SIRS死亡组(P<0.05)。以住院存活或死亡为应变量的Logistic回归分析显示,APACHEⅡ评分及血小板减少症与危重烧伤患者预后密切相关(OR值分别为1.547、0.015,P值分别为0.031、0.046)。结论血小板计数的动态变化可作为预测危重烧伤患者病情变化及预后的一项重要指标。

Objective To explore the value of the dynamic changes of platelet count in assessing the severity and prognosis of critically burned patients. Methods One hundred and thirty-one critically burned patients were divided into two groups： systemic inflammatory response syndrome （SIRS） and non-SIRS, according to the criteria of SIRS. SIRS group was classified as survial group and death group according to the outcome. Dynamic changes of platelet count and Acute Physiology and Chronic Health Evaluation Ⅱ （ APACHE Ⅱ） scores were recorded after hospitalization for 1,4, 7, 10, 14 days. Results The platelet count of each group decreased significantly in the fourth day after admission, then continued to increase. The platelet count in non-SIRS group was higher than that in SIRS group （P 〈 0.05） on the 4, 7, 10, 14 days. The platelet count in survial group at each timepoint was higher than that in death group （ P 〈 0.05）. The APACHE II scores in non-SIRS group were significantly lower than those in SIRS group （ P 〈 0.05） , The APACHEⅡ scores in survial group were also lower than those in death group （ P 〈 0.05 ）. Logistic regression analysis with hospital mortality as dependent variable showed that APACHEⅡ scores and the occurrence of thrombocytopenia were significantly related with hospital mortality of critically burned patients. Conclusion The dynamic changes of blood platelet count can be an important index in predicting the severity and prognosis of critically burned patients.