脓毒症相关血小板减少症

重组人血小板生成素用于治疗脓毒症相关性血小板减少症的疗效和安全性冯颂乔;顾金萍;于健【期刊名称】《中国农村卫生》【年(卷),期】2018(000)014【摘要】目的:研究重组人血小板生成素(rhTPO)对脓毒症相关性血小板减少症患者的临床疗效和药物安全性.方法:选取2015年6月至2016年6月在我院ICU病房住院治疗的75例脓毒症相关性血小板减少症患者按照随机数字表法分成实验组(TPO组)和对照组.观察第1-7天两组患者血小板计数,出血情况,血制品输注情况,凝血功能,肝、肾功能,ICU病死率和药物不良反应.结果:治疗后第3-7天,TPO组血小板计数(?109/L)明显高于对照组;TPO组用药后血小板恢复≥100?109/L,所用天数明显少于对照组;TPO组血小板等血制品输注量[血小板(2.07±1.84)U,新鲜冰冻血浆(235.97±80.52)ml,浓缩红细胞(2.75±1.07)U]明显少于对照组[(血小板(3.32±1.22)U,新鲜冰冻血浆(309.53±66.78)ml,浓缩红细(3.66±0.96)U];两组凝血功能对比,rhTPO组凝血功能恢复优于对照组;用药前后肝、肾功能的差异均无明显统计学意义;两组均无药物不良反应发生.结论:rtTPO能够明显升高脓毒症相关性血小板减少症患者的血小板数量,明显减少患者输注浓缩血小板等血制品的数量,同时对肝、肾功能无影响,未见药物不良反应,减少治疗费用,值得临床进一步研究和推广应用.【总页数】2页(P10-11)【作者】冯颂乔;顾金萍;于健【作者单位】大连医科大学附属第二医院中心ICU 116044;大连医科大学附属第二医院中心ICU 116044;大连医科大学附属第二医院中心ICU 116044【正文语种】中文【中图分类】R4【相关文献】1.重组人血小板生成素用于治疗脓毒症相关性血小板减少症的疗效和安全性2.重组人血小板生成素和免疫球蛋白治疗脓毒症相关性血小板减少症的临床疗效观察3.重组人血小板生成素治疗脓毒症相关性血小板减少症的临床效果分析4.重组人血小板生成素联合免疫球蛋白治疗脓毒症相关性血小板减少症疗效评价5.重组人血小板生成素治疗脓毒症相关性血小板减少症临床疗效的Meta分析因版权原因，仅展示原文概要，查看原文内容请购买。

特比澳治疗脓毒症相关性血小板减少症1例李艳;王兵;王勇强【期刊名称】《天津医科大学学报》【年(卷),期】2012(018)002【摘要】研究显示,脓毒症是危重患者发生血小板减少的独立风险因素,35%～59%的脓毒症患者会出现血小板减少。

脓毒症患者血小板进行性下降往往提示预后不良。

本院ICU应用特比澳成功治疗脓毒症相关性血小板减少症患者1例,现报告如下。

1病例介绍1．1临床资料患者，高××，女性，82岁，于2011年10月18日主因间断水肿，少尿7月余人院。

患者在治疗过程中病情加重，以心功能不全、呼吸衰竭、肾功能不全于2011年11月21日转入ICU行机械通气，床旁血液净化治疗。

【总页数】2页(P269-270)【作者】李艳;王兵;王勇强【作者单位】天津医科大学一中心临床学院ICU,天津300192;天津市第一中心医院ICU,天津300192;天津市第一中心医院ICU,天津300192【正文语种】中文【中图分类】R558+.2【相关文献】1.特比澳治疗化疗后血小板减少症临床疗效观察 [J], 周建伟;李远旦;项瑛英;李媛;潘红霞2.脓毒症相关性血小板减少症的危险因素及对脓毒症患者预后的影响 [J], 王家泽3.儿童免疫性血小板减少症治疗中特比澳联合常规剂量丙种球蛋白的疗效研究 [J], 高健;徐刚4.重组人血小板生成素联合免疫球蛋白治疗脓毒症相关性血小板减少症疗效评价[J], 彭秋琰;洪燕;刘光明;宋永玲;王强;熊雨美;朱翠平5.重组人血小板生成素治疗脓毒症相关性血小板减少症临床疗效的Meta分析 [J], 金光勇;胡炜;郑永科;刘炳炜;叶瑞;李沂玮;席绍松因版权原因，仅展示原文概要，查看原文内容请购买。

免疫球蛋白治疗脓毒血症相关性血小板减少症的疗效黄天然;苏木珍;吕波;何海燕【期刊名称】《锦州医科大学学报》【年(卷),期】2017(038)002【摘要】目的观察免疫球蛋白治疗脓毒血症相关性血小板减少症的临床疗效.方法选取2015年7月至2016年7月我院接受治疗的65例脓毒血症相关性血小板减少症患者作为研究对象,按随机数字表法将患者分为对照组32例和观察组33例,对照组给予内科综合治疗,观察组在对照组基础上给予免疫球蛋白静脉滴注治疗,于治疗前与治疗后1、3、5 d,检测两组患者的血小板计数,急性生理和慢性健康状况评分Ⅱ（APACHEⅡ）评分的变化,并统计两组治疗期间的出血发生率、28 d病死率以及ICU入住时间.结果于治疗后第3天起,观察组的血小板计数明显高于对照组,APACHEⅢ评分明显低于对照组,差异均有统计学意义（P＜0.05）;观察组的出血发生率、28 d病死率与ICU入住时间均明显少于对照组,差异均有统计学意义（P＜0.05）.结论采用免疫球蛋白治疗脓毒症相关性血小板减少症可显著提高血小板数目,减少出血风险及患者死亡,故应予推广.【总页数】4页(P19-22)【作者】黄天然;苏木珍;吕波;何海燕【作者单位】[1]肇庆市第一人民医院儿科,广东肇庆526000;[2]肇庆市第一人民医院内分泌内科,广东肇庆526000【正文语种】中文【中图分类】R588.2【相关文献】1.免疫球蛋白治疗脓毒血症相关性血小板减少症的疗效 [J], 黄天然;苏木珍;吕波;何海燕2.静脉注射免疫球蛋白辅助治疗脓毒症相关性血小板减少症的疗效 [J], 彭绵;方伟强;蔡举瑜;吕丽燕3.重组人血小板生成素和免疫球蛋白治疗脓毒症相关性血小板减少症的临床疗效观察 [J], 陈宇辉4.重组人血小板生成素联合免疫球蛋白治疗脓毒症相关性血小板减少症疗效评价[J], 彭秋琰;洪燕;刘光明;宋永玲;王强;熊雨美;朱翠平5.应用大剂量静脉注射用免疫球蛋白治疗妊娠合并血小板减少症的治疗效果以及对母婴预后的影响观察 [J], 张淑娥因版权原因，仅展示原文概要，查看原文内容请购买。

第34卷第8期2021年4月医学信息Journal of Medical InformationVol.34No.8Apr.2021论著血小板减少联合PCT评估脓毒血症患者预后的价值王繁静打张瑛2(昭通市第一人民医院重症医学科\检验科2,云南昭通657000)摘要：目的分析血小板减少值(PLT冤和降钙素原(PCT)对脓毒血症患者预后的评估价值遥方法选取我院2018年6月~2020年6月重症监护室收治的113例脓毒血症患者，根据患者30d內存活情况分为存活组(77例)和死亡组(36例冤，比较两组入院时PCT、PLT水平、入院3天PLT水平，采用受试者工作特征(ROC)曲线评价患者入院时PCT水平和PLT减少值对脓毒血症预后的评估价值遥结果存活组入院时PCT水平低于死亡组，差异有统计学意义(PV0.05)；存活组患者入院时及入院3天PLT水平均高于死亡组，且PLT减少值低于死亡组，差异有统计学意义(PV0.05)；两组入院时PCT水平与入院时PLT、入院3天PLT水平呈负相关，且与PLT减少值呈正相关(PV0.05)；ROC曲线显示，PCT、PLT减少值单独及联合评估患者预后的曲线下面积分别为0.829、0.848、0.933,两者联合诊断的曲线下面积、灵敏度、特异度、阳性和阴性预测值均高于单一指标遥结论PCT与PLT联合检测对脓毒血症患者病情危重程度及预后的评估具有重要意义，可作为患者病情评估及预后的指标遥关键词：血小板；降钙素原曰脓毒血症中图分类号：R459.7文献标识码：A DOI:10.3969/j.issn.1006-1959.2021.08.027文章编号：1006—1959(2021)08—0106—03The Value of Thrombocytopenia Combined with PCT in Evaluatingthe Prognosis of Patients with SepsisWANG Fan-jing1,ZHANG Ying2(Department of Critical Care Medicine*,Department of Laboratory Medicine2,the First People's Hospital of Zhaotong,Zhaotong657000,Yunnan,China)Abstract:Objective To a nalyze the prognostic value of thrombocytopenia(PLT)and procalcitonin(PCT)in patients with sepsis.Methods113 patients with sepsis admitted to the intensive care unit of our hospital from June2018to June2020were selected.Patients were divided into survival group(77cases)and death group(36cases)according to their survival within30d.PCT and PLT levels at admission,and PLT levels within3dof admission were compared between the two groups,and the receiver operating characteristic(ROC)curve was used for evaluation.The value of PCT level and PLT reduction on admission to the prognosis of sepsis.Results The PCT level of the survival group was lower at admission than the death group,the difference was statistically significant(P<0.05);The PLT levels of patients in the survival group were higher at admission and3d after admission than in the death group,and the reduction in PLT was lower than that of the d eath group,the difference was statistically significant(P< 0.05);The PCT level at admission of the two groups was negatively correlated with PLT at admission and PLT at3dafter admission,and positively correlated with PLT reduction(氏0.05);The ROC curve showed that the area under the curve for PCT and PLT reductions individually and jointly to assess the prognosis of patients are0.829,0.848,and0.933,respectively.The area under the curve,sensitivity,specificity,positive and negative predictive values of the combined diagnosis of the two were all higher than those of single index.Conclusion The combined detection of PCT and PLT is of great significance for the evaluation of the criticality and prognosis of patients with sepsis,and can be used as an indicator for the evaluation of the patient's condition and prognosis.Key words：Platelets;Procalcitonin;Sepsis脓毒血症(sepsis)是指患者因感染导致的机体炎症反应综合征(SIRS),可对患者的预后造成严重的影响,随着病情的进展可发生细胞循环代谢功能障碍，出现感染性休克,是导致我国住院重症监护室(ICU)患者死亡的重要原因。

• 48 •中丨外丨丨叫眹结合总救杂志2021年2月第28卷第1期Q i i丨丨J T(:M\X M(:r i丨C a r匕h V丨m m n2021，V(»1.28,N〇.l•论著•联合使用维生素C、维生素B1及氢化可的松对脓毒症血小板减少症患者疗效的影响杨蕊1蒋佳维2王勇强11天津市第一中心医院重症医学科，天津市急救研究所，天津300192; 2天津医科大学一中心临床学院，天津300070通fH作者：王勇强，Email : yongqiangwangl%**********【摘要】目的观察联合使用维生素C、维生素B1及氢化可的松对脓毒症血小板减少症(TCP)患者血小板活化的影响方法采用前瞻性研究方法，选择2019年3月至2020年3月入住天津市第一中心医院重症监护病房（ICU)的脓毒症TCP患者135例作为研究对象采用不平衡指数最小原则根据年龄、急性生理学与慢性健康状况评分II (APACHE丨1)和血小板汁数（PLT)将患者分为联合用药组（50例)、维生素C组（45例）和对照组(40例）3组患者均根据相关指南规范进行抗感染及对症支持治疗联合用药组患者在常规治疗基础上加用维生素C注射液1.5g、每1次，维生素丨U注射液200 mg、每12h 1次，氢化可的松注射液每I次；维生素C组在常规治疗基础上仅加用维生素C注射液1.5 g、每6 h 1次；对照组仅给予抗感染及对症支持治疗，3组疗程均为4 d ,检测3组患者人住丨CI丨时和治疗1、2、3、4 d后PLT水平以及入住丨C U当日和治疗4 (丨后血浆可溶性CD40配体(s(:l)40L)、溶性P选择素（S P-选择素）水平，并观察不良反应发生情况结果随治疗时间延长，3组PLT水平逐渐升高，治疗1d开始维生素C组和联合用药组与本组治疗前比较出现统计学差异(X107L :^隹•生素（：组为 70.84±9.42 比 62.13±8.86,联合用组为74.30±7.83 比 63.14±9.30,均/)<0.05);治疗4 (丨后达峰值，且联合用药组PLT水平明高于维生素C组和对照组（X107L: 100.62 ± 10.92比78.98 ± 10.59、74.45±丨丨.32,均PC0.05): 3组治疗后S(:D40L、sP-选择素均较治疗前降低，且联合用药组S CD40L、《P-选择素均明 W.低于维生素C 组和对照组 U a)40L(ng/L) : 3.48± 1.23 比 4.37± 1.43、7.15± 1.99, sP-选择素（W U :166.76±27.95比238.52±36.67、346.09±38.68,均P C0.05〕3组均未出现相关不良反应：结论维生素C、维生素B1及氢化可的松联合治疗可保护脓毒症TCP患者内皮功能，减少血小板活化，改善血小板减少状态 【关键词】维生素C;维生素m;氢化可的松；脓毒症血小板减少症；血小板活化基金项目.•国家临床重点专科建设项H (2011-873);天津市卫生行业重点攻关项目（14K r,101);天津市第一中心医院科技基金（CM20丨809)临床试验注册：中国临床试验注册中心，ChiCTR 1800019038DOI ：10.3969/j.issn. 1008-9691.2021.01.012Clinical efficacy of combination of vitamin C, thiamine and hydrocortisone in treatment of septic patients with thrombocytopenia Yang Rui1. Jiang Jiaivei\ Wang Yongqiang1'Department o f Critical Care Medicine, Tianjin First Center Hospital, Tianjin Institute of Emergency Medicine, Tianjin300192, China;2the First Center Clinical College, Tianjin Medical University, Tianjin 300070, ChinaCorresponding author: Wang Yongqiang, Email:**************************【Abstract】Objective To observe the effect of vitamin C, thiamine and hydrocortisone in f-omhination onplatelet activation in septic patients with thromhorylopenia (T(]F). Methods Prospective study was used; the 135septic [)atients with TCP in intensive rare unit (ICU) of Tianjin First (Central Hospilal from March 2019 to M arc h 2020were selected as research objects. According to the principle of minimum imbalance index and based on age, anilephysiology and chrnnir health evaluation II (APACHE 11) score and platelet count (PI.T), the patients were dividedinto 3 groups: combination grouj) (50 cases), vitamin C group (45 cases) and control group (40 rases). The three groupsrereived regular anti-infertion therapy anti symptomatic support therapy according tn the related guideline. On thebasis of ronventional and anti-infection treatment, vitamin C injection 1.5 g/6 h, thiamine injection 200 mg/12 h andhy<IrcK*ortisone 50 mg/6 h were applied in the romhination treatment group; the vitamin C injection 1.5 g/6 h was used invitamin (] group and only anti infection and symptomatic support treatment were given to the control group, ihe therapeulircourse being 4 days in the 3 groups. T h e*levels of semm PLT were measured at ICl) admission and 1, 2, 3, 4 days duringIrealmenl, and the levels of plasma soluble (]D40 ligand (SCD401.) and soluble P-selertin (sP-selec tin) were measuredat ICll admission and after 4 flays of trealmenl. The ocrurrence of adverse reactions was ohservefl. Results Withthe prolongation of treatment, the PIT levels of three groups were gradually increased after treatment, after 1day ofIreatmenl, the PLT levels in vitamin (]group and romhinalion Ireatmenl group had signifirant differences from those beforMreatment (X l〇4/L: 70.84±9.42 vs. 62.13 ±8.86 in vitamin (: group, 74.30±7.83 vs. 63.14±9.30 in r(、ml)inati(mtrealmenl group, lioth P< 0.05], and the PLT levels reached the peak values on 4 days after treatment, and llu* levelwas signifirantly higher in romhination treatment group than those in vitamin C group and control group (X l〇y/L:100.62 ± 10.92 vs. 78.98 ± 10.59, 74.45 ± 11.32, both P < 0.05). AiW treatment, the levels of sCI)40L and sP-selertin inthe 3 groups were lower than those before treatment, and the levels in combination treatment group were signifirantly lowerthan those in vilaniin C group and ( ontrol group [s(:L)40L (ng/L): 3.48 ± 1.23 vs. 4.37 ± 1.43, 7.15 ± 1.99, sP-sdertin ^中国中两医结合急救杂志2021年2月第28卷第1期C h i n J T(:M W M(:rit G t t v,F e h n m r》2021，\ <>丨.28, N o.l• 49 •166.76 ±27.95 vs. 238.52 ±36.67, 346.09 ±38.68, all P < 0.05j. No related adverse reartion was s汁n in the 3 groups. Conclusion ('.omhinatinn of vilaniine C., thiamine and hydrorortisone treatment could proterl the endothelial function,down regulate platelet activation anrl improve the situation of low PI/P level in patients with sepsis TCP.【Key words】Vitamin (:: Thiamine; Hydmrortisone: Sepsis thrnmhorvlopenia; Platelet ac tivalirmFund program：National Clinical Key Specialty Construction Project of China (2011-873); Tianjin Medical andHealth Key Research Project (14KG101); Tianjin First Central Hos[)ital Science and Technology Fund (CM201809) Trial Registration: Chinese Clinical Trial Registry, ChiCTH 1800019038D() I：10.3%9/j. issn. 1008-9691.2021.01.012脓毒症是宿主对感染反应失调而导致危及生 命的器官功能障碍感染引起的血小板i十数（PLT)减少是脓毒症的常见并发症,其减少程度及持续时 间是预测患者病死率的独立危险因素i1维生素C 是一种高效的抗氧化剂,可有效降低氧化应激反应；氢化可的松是肾上腺皮质激素，具有抗炎、抗过敏 及抑制免疫等药理学作用；维生素B1是人体氨基 酸代谢、神经递质7 -氨基丁酸（G A B A)的重要辅 酶。