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1、,相子血小标浦小丝,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可能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无论何种原因所致的严重血小板减少,都可引起典型的出血,IC患者血小板减少的因素pseudo-thrombocy to peniaEHm少HemodilutionIncreased platelet n3 A N BiD k(b at er armis,fungearnisnsfusi
2、on of red bloodconsump tiona,burns,shock,infe ction,ob st et rical cois liver cirrho sis,moticmienovascula r d iso rdersI Increased plateletdestructiontransfusion purpurap lat elet allo ant bodiesDecreased plateletproductionisease/Chron ic al cohol abuza with folat a deficiencyer式 tem cellstranIncre
3、ased platelet Hrp ersplsnism.Hsposeq uestrationGreinacher a eller K Hematology Am Soe Hermatdl Educ Program.2019 135-143.,血小板减少的症状血小板减少可以引起一系列症状如如鼻出血,牙龈出血,口腔粘Petechiae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(Thrombocytopenia17.3%脓毒症病人7.582.7%92.5%非脓毒症病人,研究表明35%-59%的
4、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 outcomes in damagecontrol resuscitation identifying blood product ratios associated withimproved survival.J Trauma,2019,65(3:527-534,I
5、n 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
6、of an adverse outcome incritically ill patients,thereby facilitating a simple and practical risk assessment in these patients and potentiallyguiding the use of complex or expensive treatment strateglesMarcel Levi,Ester C.Lowenberg Thrombocytopenia in Critically IllPatients.Semin Thromb Hemost.2019.3
7、4(5:417-424,脓毒症时基本免疫反应途径Pattern recognitioJ Protease-activated receptorsCytokineLPS(and other microbial mediatorsKininsCompleterMonocyteInflammationCoagulationAbbreviations:TF,tissue factor,PAF,platelet activating factor:NO,nitric oxide,大于00血小板图1不同血小板计数的腹腔感染病人的病死率,r=0117P01001204油翻ZHILIHIMEDIANIPLHILHLALLI图2血小板计数与 APACHE II评分的关系,
