严重脓毒症患儿血小板减少原因剖析及处理对策分析

The 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血小板减少的原因及临床处理措施。方法 72例严重脓毒症患儿根据预后分为死亡组及存活组,对血小板计数变化与预后关系进行分析;结合凝血功能监测与骨髓细胞学检查分析血小板减少的原因。结果死亡组与存活组相比,入院当天及入院后第7天血小板计数差异有统计学意义(P<0.05)。29例血小板减少患儿中,20例(68.97%)伴有凝血功能异常;9例(31.03%)骨髓巨核系成熟障碍;13例血小板<50×109/L中给予积极处理11例(84.62%),纠正7例(63.64%),死亡4例(36.36%);未能积极处理2例(15.38%),全部死亡。结论血小板持续进行性下降提示预后差。血小板减少有两大原因,一是凝血功能障碍致血小板过度消耗;二是骨髓巨核系成熟障碍。二者处理措施有别,针对病因积极处理可显著改善预后。

Objective To investigate the reasons of thrombocytopenia and its therapy strategy in children with severe sepsis by monitoring peripheral blood routine test,myelogram and coagulation function evaluation.Methods 72 patients of children with severe sepsis were divided into two groups according to survival（n=58）or death（n=14）.The relationship of the dynamic changes of blood platelets count and the prognosis between the two groups was analyzed.Combined with coagulation function examination and marrow morphology analysis,the reasons of thrombocytopenia in sepsis were investigated.Results There was a significant difference of blood platelets count on the day of admission and 7th day after admission between the survival group and the death group.In the 29 children with thrombocytopenia,20 cases（68.97%） were accompanied with coagulation disorder and 9 cases（31.03%） with megakaryocytes dysmaturity of bone marrow.In the 13 children with PLT50×109/L,11 cases（84.62%） were given active management,and their blood platelets count was corrected in 7 cases（63.64%）,4 cases died（36.36%）,while 2 cases（15.38%） without active management died both.Conclusion The continuous decline of peripheral blood platelets count prognosticated poor prognosis.There were two main causes for thrombocytopenia,the first one was coagulation disorder and microthrombosis inducing platelets excessively consumed,and the other was that megakaryocytes dysmaturity of bone marrow.The prognosis was significantly improved by active management aimed directly at different etiology.