脓毒症患者行CRRT时合并严重血小板减少不同治疗的疗效比较

Comparing the efficacy of different treatments in sepsis patients using CRRT with serious thrombocytopenia

目的:目前脓毒症患者行连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)治疗过程中合并严重血小板减少症者的发病率高。一般认为血小板数低于50×10^9/L者继续给予有创诊疗如CRRT者需给予相应治疗。本文通过回顾研究小样本的这类患者,比较输新鲜血小板、输冰冻血小板、使用重组人血小板生成素、使用重组人血小板生成素联合输新鲜血小板的治疗效果,以期为脓毒症需持续给予CRRT合并血小板减少时的治疗提供一定的帮助。方法:以2011年1月至2016年11月镇江市第一人民医院重症医学科118例行CRRT后外周血小板计数下降至≤50×10^9/L的118例脓毒症患者为研究对象,依据治疗方法不同分为未治疗组(23例)、新鲜血小板组(29例)、冰冻血小板组(25例)、重组人血小板生成素组(20例)、重组人血小板生成素及新鲜血小板组(21例)。观察比较各组治疗后24 h与72 h时的治疗反应。结果:当治疗前血小板处于不同水平对各种治疗疗效反应不同。当血小板数<30×10^9/L时,所有治疗方法疗效在24 h及72 h评估均不理想;单用重组人血小板生成素疗效最差与未治疗组无统计学差异,其余3组治疗疗效差异无统计学意义(P>0.05)。此时治疗上应以输血小板治疗为主,输新鲜血小板与冰冻血小板疗效差异无统计学意义(P>0.05)。当血小板数(30~50)×10^9/L时,输冰冻血小板较新鲜血小板及新鲜血小板联合药物组治疗24 h疗效相近,但治疗72 h后疗效差,且联合治疗组在72 h时疗效略优于输新鲜血小板,但无差异统计学意义(P>0.05);单用重组人血小板生成素可在一定程度上减缓血小板的下降幅度;最佳治疗为输新鲜血小板,也可选用重组人血小板生成素联合输血小板共同治疗,无血源时,重组人血小板生成素亦可考虑使用。结论:脓毒症患者行持续CRRT合并血小板减少时,应根据患者外周血血小板计数,给予不同的治疗方案。

Objective:Currently the prevalence rate of sepsis patient with serious thrombocytopenia during the treatment of continuous renal replacement therapy(CRRT)is still high,usually considered that platelet count less than 50×10^9/L to continue to give invasive diagnosis and treatment,such as CRRT who need to give the corresponding treatment.This article use a retrospective study of a small samples of these patients comparing the treatments response of transfusion of fresh platelets,frozen platelet transfusion,recombinant human thrombopoietin,recombinant human thrombopoietin combined with infusion of fresh platelets,it is desirable for provided some help to clinical treatment for sepsis patients with thrombocytopenia who need uninterruptible CRRT.Methods:All 118 patients with sepsis whose peripheral platelet count decreased to≤50×10^9/L after CRRT treatment in our department from January 2011 to November 2016 were selected as the research objects.According to the different treatment methods,they were divided into three groups:untreated group(23 cases),fresh platelet group(29 cases),frozen blood platelet group(25 cases),recombinant human thrombopoietin group(20 cases),and fresh platelet group(21 cases).The treatment reactions of 24 h and 72 h after treatment were compared and observed.Results:The platelet count before treatment was in different levels on the rest of the various treatment response is different.when the platelet count<30×10^9/L,all treatment methods were ineffective evaluated after 24 h and 72 h;the efficacy of recombinant human thrombopoietin alone and untreated group were the worst,and there were no significant differences in the other three groups curative effect;mainly therapy is platelet transfusion,lose fresh platelets and frozen apheresis platelets had no significant difference,when platelet count(30–50)×10^9/L,frozen platelet compared with fresh platelets and fresh platelets in the combination group treated curative efficiency was weaker after 24 h,but weaker after 72 h,and the combination group treatment was a little better than giving fresh platelets but no significant difference between the two group;using recombinant human thrombopoietin alone can slow down the platelet in a certain extent of the decline in margins;optimal treatment is transfusion of fresh platelets with or without recombinant human thrombopoietin,recombinant human thrombopoietin can also be considered with no blood products.Conclusion:Sepsis patient continued CRRT treatment with thrombocytopenia,should be based on the number of peripheral blood platelet count,to choose the different treatment option.