脓毒症相关血小板减少症.pptxVIP

脓毒症相关血小板减少症 血小板减少症(Thrombocytopenia)概述血小板减少症(Thrombocytopenia)是指血小板记数低于正常范围所引起的病症 。血小板减少症分类:继发性血小板减少症和特发性血小板减少症。血小板减少症的原因估计源于血小板产生不足,脾脏对血小板的阻留,血小板破坏或利用增加以及被血液被稀释,不管何种原因所致的严重血小板减少,都可引起典型的出血。 ICU患者血小板减少的因素 血小板减少的症状血小板减少能够引起一系列症状,如如鼻出血,牙龈出血,口腔粘膜出血,胃肠道也可出血、还可出现月经血量多、血尿等。皮肤上可出现大小不等的出血点或淤斑,多见于四肢,以下肢最常见,称为“紫癜”。 ICU病人的血小板减少症(Thrombocytopenia)脓毒症病人非脓毒症病人82、7%17、3%7、5％92、5％ 研究表明35%-59%的脓毒症患者可发生血小板减少,血培养阳性的患者血小板下降的发生率高达79、6%。越来越多的研究证实,血小板是介导严重脓毒症患儿凝血和炎症反应的关键因素,是联系内源性和获得性免疫应答的桥梁,脓毒症发病过程中的多种因素促发血小板与内皮细胞的相互作用。Gunter OL Jr,Au BK,Isbell JM,et al、 Optimizing outes in damage control resuscitation: identifying blood product ratios associated with improved survival、 J Trauma,2008,65(3):527-534 In case of systemic inflammatory syndromes, such as the response to sepsis, disseminated intravascular platelet activation may occur, which will contribute to microvascular failure and thereby play a role in the development of organ dysfunction、 A low platelet count is a strong and independent predictor of an adverse oute in critically ill patients, thereby facilitating a simple and practical risk assessment in these patients and potentially guiding the use of plex or expensive treatment strategies、Marcel Levi, Ester C、 L?wenberg、Thrombocytopenia in Critically Ill Patients、Semin Thromb Hemost、2008、34(5): 417-424 脓毒症时基本免疫反应途径 r=0117,P01001 陈德昌, 李红江, 毛居卫, 等、 血小板及骨髓象变化在危重病临床监测中的意义[J]、 中华急诊医学杂志, 2002, 11(1): 40-42、 血小板减少在感染性疾病特别是脓毒症中越来越表现为一个重要的、独立的与发病率和死亡率相关的指标。多项研究显示,在ICU病人中血小板减少与多器官功能衰竭及死亡率之间存在紧密的关系,在这些患者中,血小板减少提示存在严重的脓毒症且预后较差ZHENYU LI,FANMUYI Y,STEVE D A、et al、Platelets as immune mediators:Their role in host defense responses and sepsis 、ThrombasisResearch、2011、127:184-188、 王娴, 邓见玲、 严重脓毒症患儿血小板减少原因剖析及处理对策分析[J]、 黑龙江医学, 2013, 37(8)、 Patients with thrombocytopenia had significantly higher serum creatinine, SOFA score, vasopressor requirement, lower PaO2/FiO2 ratio and higher mortality than those without thrombocytopenia (P 0、05)、 Higher SOFA score, low P(a)O2/FiO2 ratio and high vasopressor dose were