危重病患者血小板减少症发病机制及治疗的研究进展

Research Progress in the Pathogenesis and Treatment of Thrombocytopenia in Critically Ill Patients

血小板减少症是重症监护病房(ICU)常见的临床现象,可作为病情严重程度的独立危险因素及病情预后的观察指标。脓毒症、药物、创伤、手术以及ICU中一些特殊治疗如连续性床旁血液滤过或主动脉球囊反搏等因素均可导致血小板减少,机制可概括为各种原因导致血小板消耗及破坏增加和(或)生成减少,血小板去唾液酸化以及免疫相关因素所导致。危重病患者病情复杂,多个导致血小板减少的危险因素常同时存在,临床须密切监测血小板变化,积极治疗原发病,当出现严重血小板减少或出血倾向时可给予重组人促血小板生成素、免疫球蛋白或唾液酸酶抑制剂治疗,必要时予输注血小板。

Thrombocytopenia is a common clinical phenomenon in patients of intensive care unit(ICU).It can be used as an independent risk factor for the severity of the disease and an observation indicator of the prognosis.Sepsis,drugs,trauma,major surgery and some special treatments such as continuous renal replacement therapy or intra-aortic balloon pump in ICU etc.can cause thrombocytopenia.The mechanism can be summarized as increased consumption and destruction of platelet and/or decrease of the platelet production of different causes,platelet desialylation and some immune factors.The critical illness is complex and multiple factors exist simultaneously.Platelet should be monitored closely to deliver active treatment of the original disease,recombinant human thrombopoietin,immunoglobulin or oseltamivir should be used when severe thrombocytopenia or hemorrhagic tendency happen,and platelets infusion should be given if necessary.