严重脓毒症患儿血小板减少原因及处理对策

Reasons of Thrombocytopenia and Its Management in Children with Severe Sepsis

目的结合血常规、凝血功能及骨髓细胞学检查,探讨严重脓毒症患儿PLT减少的原因及临床处理措施。方法选取严重脓毒症患儿72例,根据预后分为存活组和死亡组,对2组患儿的PLT计数与预后关系进行分析;分析PLT减少患儿入院时脏器累及情况;结合凝血功能监测与骨髓细胞学检查分析PLT减少的原因及其处理对策。结果死亡组入院当天及入院后7 d PLT计数与存活组相比有统计学差异。PLT<80×109L-129例患儿入院时受累器官数目≥3个19例(65.5%),死亡8例(27.6%);而PLT<50×109L-113例中受累器官数目≥3个10例(76.9%),死亡6例(46.2%)。14例死亡患儿中因PLT重度减低/DIC致重要脏器出血死亡6例(42.9%)。29例PLT减少患儿中,20例(69.0%)伴有凝血功能异常,9例(31.0%)伴骨髓巨核系成熟障碍。13例PLT<50×109L-1患儿中给予积极处理11例(84.6%),死亡4例(36.4%);未能积极处理2例(15.4%),全部死亡。结论PLT持续进行性下降提示预后差;针对PLT减少病因积极处理可显著改善预后。

Objective To investigate the reasons of thrombocytopenia and its management strategy in children with severe sepsis by monitoring peripheral blood routine test, myelogram and coagulation function. Methods Seventy - two children with severe sepsis were divided into the survival group and the death group according to their prognosis. The relationship of the dynamic changes of blood platelets count and the prognosis between the 2 groups was analyzed. The number of organs involved by severe sepsis accompanied with thrombocytopenia at the admission day was evaluated. Combined with coagulation function examination and marrow morphology analysis, the reasons of thrombocytopenia were investigated. The patients with lower blood platelets count were given active management. Results There was a significant difference of blood platelets count on the day of admission and the 7th day after admission between the survival group and the death group. In the 29 children with PLT 〈 80 ×10^9L-1, the number of involved organs was 3 or more on the day of admission in 19 patients （65.5 % ） , in which 8 cases died （27.6%）. In the 13 children with PLT 〈 50 ×10^9L-1, the number of involved organs was 3 or more in 10 patients （76.9%）, in which 6 cases died （46.2%）. The cause of death was vital organ bleeding induced by severe thrombocytopenia/DIC in 6（42.9% ） cases of the all 14 death cases. In the 29 children with thrombocytopenia, 20 cases （69.0%） were accompanied with coagulation disorder and 9 cases （31.0% ） with megakaryocytes dysmaturity of bone marrow. In the 13 children with PLT 〈 50 ×10^9L-1, 11 cases （84.6%） were given active management,4 cases died （ 36.4% ） ,while 2 cases （15.4%） without active management died both. Conclusions The continuous decline of peripheral blood platelets count prognosticated poor prognosis. The prognosis was significantly improved by active management aimed directly at different etiology.