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目的:回顾性分析接受连续性静脉-静脉血液滤过(CVVH)的患者中血小板下降与血小板减少症(TP)的发生率和相关的危险因素。方法:2008年11月至2012年10月在南京军区南京总医院肾脏科首次行CVVH治疗,72h、有连续4d血常规记录的患者纳入研究,排除除脓毒症外有其他因素可能影响血小板计数(PLT)的患者。分析治疗前后PLT、疾病严重程度和预后。结果:共纳入125例接受CVVH治疗的危重症患者,男性97例,女性28例。平均年龄51.8±18.7岁,平均APACHEⅡ评分17.8±6.5分。CVVH治疗3d内,60.8%的患者PLT下降≥20%(血小板减少),16.0%的患者PLT下降≥50%(严重血小板减少)。TP(PLT≤100×109/L)和严重TP(PLT≤50×109/L)的发生分别为53.6%和16.0%。严重血小板减少组相比无严重血小板减少的患者生存率有显著性降低(35.0%vs 59.0%,P=0.012),而严重TP相比无严重TP患者生存率无显著性差异(45.0%vs 57.1%,P=0.308)。多因素回归分析显示CVVH中严重血小板减少的独立的危险因素包括女性、高龄、较长病程;严重TP的独立危险因素为治疗前TP。结论:在接受CVVH治疗的患者中血小板减少和TP的发生十分常见。CVVH治疗后PLT下降幅度相比PLT更可能影响生存率。临床需要我们识别CVVH中严重血小板减少的高危因素,预防严重血小板减少的发生。
OBJECTIVE: To retrospectively analyze the incidence of thrombocytopenia (TP) and associated risk factors in patients undergoing continuous venovenous hemofiltration (CVVH). Methods: From November 2008 to October 2012, patients undergoing CVVH for the first time were enrolled in the Department of Nephrology, Nanjing General Hospital of Nanjing Military Command. After 72 hours, patients with continuous 4-day routine blood tests were enrolled in the study to exclude other factors besides sepsis, which may affect platelet count (PLT) patients. PLT before and after treatment, disease severity and prognosis. Results: A total of 125 critically ill patients treated with CVVH were enrolled. There were 97 males and 28 females. The mean age was 51.8 ± 18.7 years and the mean APACHEⅡ score was 17.8 ± 6.5. Within 3 days of CVVH treatment, PLT decreased ≥20% (thrombocytopenia) in 60.8% of patients and ≥50% PLT (severe thrombocytopenia) in 16.0% of patients. The occurrence of TP (PLT≤100 × 109 / L) and severe TP (PLT≤50 × 109 / L) were 53.6% and 16.0%, respectively. The survival rate of patients with severe thrombocytopenia was significantly lower than that of patients without severe thrombocytopenia (35.0% vs 59.0%, P = 0.012), while no significant difference was found between severe TP and non-severe TP (45.0% vs 57.1 %, P = 0.308). Multivariate regression analysis showed that independent risk factors for severe thrombocytopenia in CVVH included female, elderly, and longer duration; the independent risk factor for severe TP was pretreatment TP. Conclusions: Thrombocytopenia and TP are very common in patients receiving CVVH. The decline in PLT after CVVH treatment is more likely to affect survival than PLT. Clinically, we identify high risk factors for severe thrombocytopenia in CVVH and prevent the occurrence of severe thrombocytopenia.