摘要
目的探讨老年重症肺部感染患者血小板改变对生存状况的预测分析。方法选取2016年1月至2018年10月于杭州师范大学附属医院入住ICU的82例重症肺部感染患者的临床资料,按照患者28 d生存状况分为存活组与死亡组,其中存活组49例,死亡组33例。收集患者入ICU 0 h、24 h、48 h、72 h血小板(platelet,PLT)计数,计算各时间点PLT变化数与患者生存状况。结果存活组重症肺部感染老年患者的血清降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)、序贯器官衰竭评估(sepsis-related or sequential organ failure assessment,SOFA)评分、慢性健康状况评分系统(acutephysiology and chronichea lthevaluation,APACHEⅡ)评分分别为(1.22±0.76)μg/L、(46.70±28.04)mg/L、(5.78±1.92)分、(17.79±8.02)分均低于死亡组的(2.38±1.41)μg/L、(87.62±41.18)mg/L、(8.42±2.61)分、(24.54±10.60)分(P<0.01);存活组重症肺部感染老年患者入ICU 0 h、24 h、48 h、72 h血小板水平为(228.51±106.43)×10~9/L、(193.54±99.18)×10~9/L、(180.07±90.03)×10~9/L、(165.48±81.41)×10~9/L均高于死亡组(166.24±85.28)×10~9/L、(137.48±70.12)×10~9/L、(94.33±45.48)×10~9/L、(79.61±33.68)×10~9/L(P<0.01);存活组重症肺部感染老年患者各时间段血小板变化数比死亡组波动更小(P<0.01);存活组重症肺部感染老年患者各时间段血小板变化率比死亡组更低(P<0.01);重症肺部感染老年患者以入ICU 72 h血小板变化率最高,其临界值为-36.00%,AUC为0.915,敏感度0.913,特异度0.773。此外,PCT、CRP、SOFA评分、APACHEⅡ评分也对患者的28d生存状况有一定预测价值。结论老年重症肺部感染患者血小板水平持续降低提示预后不良,结合患者72h血小板水平、血小板变化数及血小板变化率可以更好地预测重症肺部感染老年患者的生存状况。
Objective To explore the association of platelet dynamic change with the survival status of senile patients with severe pulmonary infection in ICU.Methods The clinical data of 82senile patients with severe pulmonary infection admitted in ICU from January 2016to October 2018were collected and patients were divided into survival group(n=49)and death group(n=33)according to the survival status on the 28th day in ICU.The dynamic change of platelet(PLT)count was monitored at 0h,24h,48h,72hin ICU and its association with the survival status of patients was evaluated.Results The serum levels of PCT,CRP and the scores of SOFA,APACHE II in survival group were significantly lower than that in death group(1.22±0.76 vs 2.38±1.41)μg/L;(46.70±28.04 vs 87.62±41.18)mg/L;(5.78±1.92 vs 8.42±2.61);(17.79±8.02 vs 24.54±10.60)(P<0.01),while the PLT counts at 0h,24h,48h,72hin ICU were significantly higher(228.51±106.43 vs 166.24±85.28)×109/L;(193.54±99.18 vs 137.48±70.12)×109/L;(180.07±90.03 vs94.33±45.48)×109/L;(165.48±81.41 vs79.61±33.68)×109/L(P<0.01).There was less change of PLT count at different time point in survival group than in death group(P<0.01),and the platelet change rate was much lower(P<0.01).The platelet change rate was the highest at 72hin ICU in the survival group with the cutoff value of-36.00%,the sensitivity of 0.913the specificity of 0.773 and AUC of 0.915.In addition,the serum levels of PCT,CRP and scores of SOFA and APACHE II were predictive indicators for 28-day survival of patients in ICU.Conclusions The continuous decreasing of platelet number indicates an unfavorable outcome of senile patients with severe pulmonary infection.The 72hplatelet level in ICU along with the platelet change number and platelet change rate can betterʍpredict the survival of patients.
作者
周三军
张秀丽
ZHOU San-jun;ZHANG Xiu-li(ICU,Affiliated Hospital of Hangzhou Normal University,Hangzhou,Zhejiang 310015,China)
出处
《中国预防医学杂志》
CAS
CSCD
2020年第3期280-283,共4页
Chinese Preventive Medicine
基金
浙江省医学会临床科研资金项目(2015ZYC-A39)
关键词
血小板
重症肺部感染
老年
生存状况
预测
Platelet
Severe pulmonary infection
Senile patients
Survival status
Prediction
