不同严重程度脓毒症患者血小板计数和功能关系的观察性研究

An Observational Study on the Relationship between Platelet Count and Function in Patients with Sepsis of Different Severity

目的探讨不同严重程度脓毒症患者血小板计数与血小板功能的关系。方法前瞻性的方便选取2017年12月—2019年4月就诊于海南省人民医院重症医学科临床诊断为脓毒症的患者,入院即行血小板计数、凝血功能指标及血栓弹力图检测。根据序贯器官衰竭评分进行分组,2~5分为轻度脓毒症组;6~9分为中度脓毒症组,10分及以上为重度脓毒症组。采用单因素方差分析比较3组各凝血指标的差异,LSD法作两两组间比较。结果入组84例,其中男性52例,女性32例,平均年龄(56.2±18.6)岁,轻度脓毒症组(n=24)、中度脓毒症组(n=32)与重度脓毒症组(n=28)相比血小板计数逐渐减少:(198.3±102.7)×10^9/L vs(138.4±92.6)×10^9/L vs(96.4±55.2)×109/L,差异有统计学意义(F=9.240,P<0.001);与轻度脓毒症组比较,中度脓毒症组血小板计数明显下降(P<0.05)。血栓弹力图指标中血块最大强度(MA)在重度脓毒症组中减小(63.4±7.8)mm vs(60.2±8.6)mm vs(46.8±6.8)mm,差异有统计学意义(F=34.5,P<0.001);但轻度脓毒症组与中度脓毒症组两组MA值比较,差异无统计学意义(P>0.05)。结论随着脓毒症严重程度的增加,血小板计数逐渐下降,但反映血小板功能的MA值仅在重度脓毒症时下降。

Objective To observe the relationship between platelet count and platelet function in patients with sepsis of different severity.Methods Prospective conveniently selection of patients with sepsis who were admitted to the Department of Intensive Care Medicine of Hainan Provincial People's Hospital from December 2017 to April 2019.Platelet counts,coagulation function indicators,and thromboelastogram testing were performed upon admission.Groups were grouped according to sequential organ failure assessment(SOFA)scores,2-5 were divided into mild sepsis group;6-9 were divided into moderate sepsis group,10 points and above were severe sepsis group.One-way analysis of variance was used to compare the differences of the coagulation indexes of the three groups,and the LSD method was used to compare the two groups.Results 84 people were enrolled,including 52 males and 32 females,aged(56.2±18.6)years old,mild sepsis group(n=24),moderate sepsis group(n=32)and severe sepsis group(n=28):platelet count gradually decreased(198.3±102.7)×10^9/L vs(138.4±92.6)×10^9/L vs(96.4±55.2)×10^9/L,the difference was statistically significant(F=9.240,P<0.001);compared with mild sepsis group,the platelet count in the moderate sepsis group was significantly decreased(P<0.05).The maximum clot strength(MA)in the thromboelastogram index decreased in the severe sepsis group(63.4±7.8)mm vs(60.2±8.6)mm vs(46.8±6.8)mm,the difference was statistically significant(F=34.40,P<0.001);but there was not statistically significant difference in MA values between the two groups in mild sepsis group and moderate sepsis group(P>0.05).Conclusion As the severity of sepsis increases,the platelet count gradually decreases,but the MA value reflecting platelet function only decreases in the severe sepsis.