重症监护病房血小板减少症患者调查分析

Analysis of thrombocytopenia patients in intensive care unit （ICU）

目的调查重症监护病房（icu）血小板减少症（TCP）发生率、预后，分析其危险因素及可能机制。方法收集2012年10月～2013年10月217例ICU患者临床资料，调查血小板减少症的发生率，对其相关危险因素进行Logistic逐步回归分析，并探讨其可能机制。结果发现血小板减少症患者76例（35．0％），病死率38．2％，显著高于非血小板减少症患者病死率5．0％（P〈0．01）。脓毒症、出血或输血、急性生理和慢性健康估测评分II（APACHEII）〉15是血小板减少症的独立危险因素。纠正血小板减少能降低血小板减少症患者的病死率。血小板减少症患者当中DIC发生率为39．5％（30例）。结论脓毒症是主要的独立危险因素，ICU中血小板减少患者病死率更高。纠正血小板减少能够改善患者预后。

Objective To investigate the incidence of thrombocytopenia in ICU, its risk factors, prognosis, as well as the possible mechanisms associated with thrombocytopenia. Methods An analysis was conducted on a total of 217 ICU patients who were admitted from Oct. 2012 to Oct 2013. The risk factors for thrombocytopenia were analyzed by the stepwise logistic regression analysis, as well as the mechanisms involved. Results A total of 76 patients （35%） were found complicated by thrombocytopenia, with a mortality rate of 38% comparing with 5.0% mortality rate in non-thrombocytopenic patients （p 〈 0.01）. Sepsis, episodes of bleeding or transfusions, and an acute physiology and chronic health evaluation （APACHE） I1 score of 〉 15 were the independent risk factors identified for thrombocytopenia. The correction of thrombocytopenia was a protective factor in reducing mortality for thrombocytopenic patients. Disseminated intravascular coagulation was found in 39.5% of thrombocytopenie patients. Conclusions Sepsis was identified for the major independent risk factor. Thrombocytopenic patients have a higher ICU mortality due to the severity of overall clinical status. Bone marrow examination could be diagnostic when no obvious causes are identified. Thromboeytopenia probably reflects the severity and course of an underlying pathologic condition, as its correction appears to be a good prognostic factor.