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-  2018 

血小板动态下降对急性呼吸窘迫综合征的预后评估价值

DOI: doi:10.7507/1671-6205.201804026

Keywords: 急性呼吸窘迫综合征, 血小板, 预后

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Abstract:

目的探究血小板变化与急性呼吸窘迫综合征(ARDS)患者预后的关系。 方法通过回顾性分析方法纳入复旦大学附属中山医院 2008 年至 2015 年收治的 275 例 ARDS 患者,从病案系统中采集患者的临床症状、实验室检查指标、疾病转归等信息。用 COX 回归分析、Kaplan-Meier 生存曲线等统计学方法分析疾病前 3 d 内血小板下降与 ARDS 预后的关系,并进行亚组分析。 结果按照纳入与排除标准,共 233 例患者入组,根据其疾病前 3 d 内血小板计数分为下降组和非下降组。单因素分析、COX 回归分析、Kaplan-Meier 生存曲线均显示两组的预后差异有统计学意义(均 P<0.05)。根据初始的血小板计数和 3 d 内血小板变化情况把所有入组患者分为 9 个亚组。通过比较这些亚组的死亡率得到两个风险组,包括持续性低血小板组(初始血小板计数<139×10 9/L,且疾病前 3 d 血小板增加<16×10 9/L),以及血小板下降组(初始血小板计数≥139×10 9/L,且疾病前 3 d 血小板下降>30×10 9/L)。其余亚组合并为非风险组。将两个风险组合并后与非风险组进行比较,单因素分析、COX 回归分析、Kaplan-Meier 生存曲线均显示风险组与非风险组的预后差异有统计学意义(均 P<0.05),各项凝血功能指标差异无统计学意义(均 P>0.05)。血小板计数也可以作为风险组中手术亚组( P=0.003)、非高血压亚组( P=0.018)和肺炎亚组( P<0.001)的独立预后指标。 结论血小板低下、血小板减少与 ARDS 的不良预后相关,可以作为临床预后评价的指标

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