论文部分内容阅读
目的 研究血小板及骨髓象变化在危重病临床监测中的意义。方法 ICU危重病患者 2 13例 ,入选标准为各种原因所致的SIRS和MODS。回顾性将病例分为死亡组 (n=6 2 ) 和存活组 (n=15 1)。入院后当天及 3、 7、 10d进行APACHEⅡ评分和血小板检查 ,入院后次日对各种体液进行细菌和真菌培养。35例患者在入ICU后 2 4小时内进行骨髓象检查。结果 入ICU时存活组和死亡组APACHEⅡ评分明显增高 ,但差异无显著意义 ;治疗 7d和 10d后 ,存活组下降至 10分以下 ,而死亡组上升至 2 0分以上 (P <0 0 1)。血小板在入院时两组均降低 ,但在治疗 7d和 10d死亡组患者血小板再度进行性下降 ,而存活组上升至正常范围 (P <0 0 0 1)。严重的阴沟杆菌感染、金黄色葡萄球菌感染 (MRA)和真菌性脓毒症 ,血小板低下的发生率分别为 72 3%、 89 6 %和 93 5 %。危重病患者骨髓象显示存活组带状核和分叶核粒细胞、浆细胞、巨核细胞明显高于死亡组 (P <0 0 5 ) ,而淋巴细胞死亡组显著高于存活组 (P <0 0 1)。结论 血小板进行性下降和骨髓抑制能较正确、敏感地反映危重病患者的病情和预后 ,而血小板检查快速、简单易行在临床上更有实用价值。
Objective To study the significance of platelet and bone marrow changes in the clinical monitoring of critical illness. Methods Twenty-one ICU critically ill patients were enrolled in this study. The inclusion criteria were SIRS and MODS due to various causes. The cases were retrospectively divided into death group (n = 6 2) and survival group (n = 15 1). APACHEⅡscore and platelet test were performed on the day after admission and on days 3, 7 and 10. Bacterial and fungal cultures were performed on the following day after admission. Thirty-five patients underwent bone marrow imaging within 24 hours of entering the ICU. Results The APACHEⅡscores in survivors and deaths were significantly higher in ICU, but the difference was not significant. After 7 and 10 days of treatment, the survivors decreased to below 10 points and the death increased to 20 points or more (P <0.01) . Platelets decreased in both groups on admission, but platelet re-descended in the 7-day and 10-day post-treatment death groups, and survived to the normal range (P <0.01). The incidence of severe C bacilli, Staphylococcus aureus (MRA) and fungal sepsis, and platelet count were 72.3%, 89.6% and 93.5%, respectively. Bone marrow samples of critically ill patients showed that the number of banded nucleus and segmented nucleated granulocytes, plasma cells and megakaryocytes in survival group were significantly higher than those in death group (P <0.05), while those in lymphocyte death group were significantly higher than those in survival group 0 1). Conclusions The progressive decline of platelets and myelosuppression can reflect the condition and prognosis of critically ill patients more accurately and sensitively. The rapid and simple platelet test is more practical in clinical practice.