持续血小板减少症预测严重烧伤并发脓毒症的临床意义

Clinical significance of continuous thrombocytopenia in predicting sepsis after severe burn

目的了解严重烧伤患者血小板减少症持续时间预测脓毒症的意义。方法回顾性分析2007年1月-2011年12月2家笔者单位收治的符合人选标准的148例严重烧伤患者的临床资料，根槲伤后30d内是否发生脓毒症将患者分为脓毒症组44例和非脓毒症组104例。统计2组患者的年龄、性别、烧伤总面积、Ⅲ度烧伤面积、伤后第1个24h补液量，伤后第1天血钙水平、血浆蛋白蛋白浓度、血小板计数，以及入院时急性生理与慢性健康评估Ⅱ（APACHEⅡ）评分、入院时有无低血容量性休克及吸入性损伤、伤后48h内有无显性弥漫性血管内凝血（DIC）、伤后3d内有无手术、伤后10d内血小板减少症持续时间、病死率，以筛选脓毒症发生的独立危险因素。对数据行t检验、检验、单因素Logistic回归分析、多因素Logistic同归分析。结果2组患者在烧伤总面积、Ⅲ度烧伤面积、伤后第1天血钙水平、伤后第1天血浆白蛋白浓度、人院时APACHEⅡ评分、人院时有无低血容量性休克、入院时有无吸入性损伤、伤后48h内有无显性DIC、病死率方面比较，差异均有统计学意义（t值为2．433～4．082，x^2值为8．818～31．528，P＜0．05或P＜0．01）；脓毒症组、非脓毒症组患者伤后10d内血小板减少症持续时间分别为（5．2±2．4）、（2．9±1．9）d，组间差异明显（t=6．189，P＜0．01）。2组患者其余指标比较，差异均无统计学意义（t值为0．971～1．250，x^2值为0．054、1．529，P值均大于0．05）,单因素、多因素Logistic回归分析最示，伤后10d内血小板减少症持续时间和入院时APACHEⅡ评分与脓毒症的发生密切相关（比值比分别为1．569、1．140，P值均小于0．01）。结论烧伤后10d内血小板减少症持续时间能反映机体动态的病理生理变化，是严重烧伤患者并发脓毒症的重要危险因素之一，对烧伤脓毒症的预测具有潜在临床应用价值。

Objective To explore the relationship between continuous thromboeytopenia and sepsis in patients with severe hurns. Methods Clinical data of 148 severely burned patients admitted to our twn burn centers from Jauuary 2007 to Deeember 2011 and conforming to tile study criteria were retrospeelively analyzed. All patients were divided into sepsis group （ n =44） and non-sepsis group （ n = 104） according to the presence or absence of sepsis within post burn day （PBD） 30. The data of age, gender, total burn area, full-thickness burn area, fluid infusion volume within post burn hour （PBH） 24, plasma concentration of calcium ion on PBI） 1 , plasma concentration of albumin on PBD 1 , platelet count on PBD 1 , acute physiology and chronic health evalualion （APACHE） Ⅱ score on admission, the presence or absence of hypovolemic shock or inhalation injury on admission, the presence or absence of disseminated intravaseular coagu- lation （DIC） within PBH 48, operation or no operation within PBD 3, thrombocytopenia duration within PBD 10, and mortality were statistically compared between two groups to screen the independent risk factors of sepsis. Data were processed with t tesl, chi-square test, single factor Logistic regression analysis, and multi-factor Logistic regression attalysis. Results Between two groups, there were statistically significant differences in lotal burn area, full-thickness burn area, plasma concentration of calcium ion on PBD 1, plasma concentration of albumin on PBD I , APACHE Ⅱ score on admission, presence or absence of hypovolemic shock on admission, presence or absence of inhalation injury on admission, presence or absence of DIC within PBH 48, and mortality （with t values from 2. 433 to 4. 082, X^2 values from 8. 818 to 31. 528, P 〈0.05 or P 〈0.01 ）. Furthermore, the duration of thrombocytopenia within PBD 10 in sepsis group was （5.2 ± 2.4） d, which was significantly longer than that in non-sepsis group [ （2.9 ± 1.9） d, t = 6. 189, P 〈0.01 ]. There were no statistically significant differences in the other indexes between two groups （with t values from 0.971 to 1. 250,X 2 values respectively 0. 054 and 1. 529, P values above 0.05）. Single factor and multi-factor Logistic regression analysis indicated that APACHE Ⅱ score on admission and duration of thrombocytopenia within PBD 10 were closely related to occurrence of sepsis （with odds ratio respectively 1. 140 and 1. 569, P values below 0.01 ）. Conclusions Duration of thrombocytopenia within PBD 10 is one of the risk factors for sepsis in severely burned patients, which can reflect pathophysiological changes in the body, thus providing predictive value for the occurrence of sepsis.