危重症患者血小板功能的评估及其临床意义

Evaluation of platelet function in critically ill patients and its clinical significance

血小板在凝血、炎症和免疫反应中起重要作用。血小板质量的变化常常影响着危重症患者的治疗及预后，并与病死率存在明显的相关性。随着对血小板功能研究的深入，发现危重症患者早期即可出现血小板质量的异常。为了更准确地评估血小板质量的变化，血小板计数（PLT）、血小板压积（PCT）、大型血小板比例（PLCR）、平均血小板体积（MPV）、血小板体积分布宽度（PDW）、未成熟血小板比例（IPF）等血小板参数成为当前重症医学领域研究的重点。同时，应用血栓弹力图/血栓弹力图血小板图（TEG/TEG MP）评估血小板功能，特别是对花生四烯酸（AA）途径抑制率、二磷酸腺苷（ADP）受体抑制率的研究，是目前研究的热点。综合应用各项血小板功能的评估方法，对危重症患者的诊断、预后及早期目标导向治疗（EGDT）具有重要意义。

Platelets play a pivotal role in the thromboembolic, inflammatory, and immunomodulatory process. The alteration of platelet quality often affects the treatment and prognosis of critically ill patients, and has a significant correlation with mortality. With the further research on the function of the platelet, it is found that the abnormal platelet quality can present during the early stage of the illness of the critically ill patients. In order to evaluate the alterations of the platelet quality more accurately, the further studies of platelet parameters, including platelet counts （PLT）, platelet hematocrit （PCT）, platelet large cell ratio （PLCR）, mean platelet volume （MPV）, platelet distribution width （PDW）, immature platelet fraction （IPF） and so on, are still be the focus of current researches in the field of critical illness. At the same time, the application of thromboelastography/thrombelastography-platelet mapping （TEG/TEG MP） to the measurement of platelet function, especially the researches on the inhibitory rate of adenosine diphosphate （ADP） and the inhibitory rate of arachidonic acid （AA）, is the hot spot of current researches. With regard to the diagnosis, prognosis and early goal-directed therapy （EGDT） of the critically ill patients, it is important to comprehensively apply the methods of platelet function evaluation.