连续性静脉?静脉血液滤过治疗中血小板减少的发生率和危险因素分析

肾脏病与透析肾移植杂志 ›› 2014, Vol. 23 ›› Issue (2): 121-127.

连续性静脉?静脉血液滤过治疗中血小板减少的发生率和危险因素分析

出版日期:2014-04-28 发布日期:2014-04-28

Incidence and risk factors of platelet decline in patients receiving continuous veno-venous hemofiltration

Online:2014-04-28 Published:2014-04-28

摘要/Abstract

摘要：

摘要目的：回顾性分析接受连续性肾脏替代治疗(CRRT)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月期间南京军区南京总医院医院首次行连续性静脉静脉血液滤过(CVVH)治疗72h以上、有连续4d血常规记录的患者纳入研究，排除除脓毒症外可能影响血小板计数的因素的患者。分析治疗前和治疗后血小板计数、血液指标、疾病严重程度和患者的预后。结果：此研究共纳入了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APACHE II评分17.8±6.5分。经过3d的CVVH治疗，60.8%的患者血小板下降超过20%（血小板减少），16.0%的患者血小板下降超过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有女性、高龄、较长病程；严重TP的独立危险因素有治疗前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治疗后血小板减少幅度相比血小板计数更可能影响生存率。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。

Abstract:

ABSTRACT Objective: A retrospective analysis was made to investigate the incidence of platelet decline and related risk factors in patients receiving CRRT. Methodology: From November 2008 to October 2012, all patients receiving continuous veno-venous hemofiltration (CVVH) in Jinling hospital were screened，Only patients matching following criteria were enrolled for further analysis: uninterrupted CVVH for more than 72h, with records of blood test for consecutive four days, ruling out pre-existing conditions maybe affecting platelet counts. The levels of platelet were counted before and during CVVH, and the illness severity, and outcome were also analyzed at the same time. Results：They were 125 patients, 97 males and 28 females, with a mean age of 51.8±18.7 years. The mean APACHE II score was 17.8±6.5. During three-day CVVH, 60.8% patients had a decline of platelet count more than 20%, and 16% patients had a decline more than 50%; the percentage of thrombocytopenia (Plt≤100×109/L) and severe thrombocytopenia (Plt≤50×109/L) was 53.6% and 16.0%, respectively. There were no differences of mean platelet volume (MPV) between before CVVH and during CVVH. The patients with platelet decline more than 50% had a significantly lower survival rate than others (35.0% versus 59.0%, P=0.012), while patients with severe thrombocytopenia had a survival rate similar with others (45.0% versus 57.1%, P=0.308). Female gender, older age and longer course of the disease were independent risk factors of platelet decline more than 50%, and thrombocytopenia before CVVH was the independent risk factor of severe thrombocytopenia after CVVH. Conclusions：Platelet decline and thrombocytopenia are quite common in patients receiving CVVH. The extent of platelet decline rather than absolute count during CVVH may affect survival rate. The risk factors of platelet decline more than 50% included female gender, older age and longer course of the disease.

Key words: Platelet decline, thrombocytopenia, continuous veno-venous hemofiltration, incidence, risk factors

邬步云| 龚德华| 徐斌| 等. 连续性静脉?静脉血液滤过治疗中血小板减少的发生率和危险因素分析[J]. 肾脏病与透析肾移植杂志, 2014, 23(2): 121-127.

WU Buyun| GONG Dehua| XU Bin| et al. Incidence and risk factors of platelet decline in patients receiving continuous veno-venous hemofiltration[J]. Chinese Journal of Nephrology, Dialysis & Transplantation, 2014, 23(2): 121-127.

ISSN 1006-298X CN 32-1425/R