目的:探讨急诊多发伤患者新生血小板状态与患者预后的相关性,分析新生血小板状态与静脉血栓(venous thromboembolic events,VTE)和多器官功能障碍(multiple organ dysfunction syndrome,MODS)的关系.方法:纳入2022年10月-2023年12月新疆医科大学第二附属医院收治的120例多发伤患者,根据患者住院7 d内死亡情况分为死亡组(44例)和存活组(76例).收集两组患者临床实验室资料,测定患者入院24 h、7 d的未成熟血小板比例(immature platelet fraction,IPF)和未成熟血小板绝对值(immature platelet counts,IPC);采用 lo-gistic 回归分析多发伤患者7 d内死亡的独立相关因素;记录所有患者入院7 d内和7 d后发生VTE和MODS情况,比较不同时间点发生VTE或MODS患者的IPF和IPC.结果:120例多发伤患者住院7 d内死亡44例,据此分组后对比两组患者临床资料显示,死亡组患者年龄、ISS评分、休克比例、收缩压、血糖、APTT水平高于存活组,血小板、24 h IPF、24 h IPC、24 h血小板平均体积、24 h血小板体积分布宽度低于存活组,均差异有统计学意义(P＜0.05);logistic 回归分析显示,年龄(OR=1.227)、ISS 评分(OR=1.549)、合并休克(OR=3.640)、血糖(OR=2.757)、24 h IPC(OR=0.029)与患者7 d内死亡独立相关(P＜0.05);RCS分析显示,24 h IPC与多发伤患者死亡风险呈显著线性关系(非线性检验P=0.478);迟发MODS患者入院7 d IPC水平高于早发MODS患者和无MODS患者,迟发VTE患者入院7 d IPC水平高于早发VTE患者和无VTE患者,差异有统计学意义(P＜0.05).结论:多发伤患者急性期未成熟血小板水平较低与死亡率增加有关,后期未成熟血小板水平较高可能引发MODS和VTE.
Association between neonatal platelet status and the risk of adverse prognosis in emergency patients with multiple injuries
Objective:To investigate the correlation between the status of neonatal platelets and prognosis in e-mergency patients with multiple injuries,and to analyze the relationship between the status of neonatal platelets and venous thromboembolism(VTE)and multiple organ dysfunction syndrome(MODS).Methods:A total of 120 patients with multiple injuries admitted to the Second Affiliated Hospital of Xinjiang Medical University from Oc-tober 2022 to December 2023 were enrolled and divided into the death group and the survival group based on their death situation within 7 days of hospitalization.Clinical laboratory data of both groups were collected,and the im-mature platelet fraction(IPF)and absolute immature platelet counts(IPC)were measured at 24 hours and 7 days after admission.Logistic regression analysis was used to identify independent factors associated with death within 7 days in patients with multiple injuries.The occurrence of VTE and MODS within 7 days and after 7 days of ad-mission was recorded,and IPF and IPC were compared among patients with VTE or MODS at different time points.Results:Among the 120 patients,44 cases died within 7 days of hospitalization.In the death group,age,ISS score,proportion of shock,SBP,blood glucose and APTT levels in the death group were higher than those in the survival group,while platelet,24 h IPF,24 h IPC,24 h mean platelet volume and 24 h platelet distribution width were lower than those in the survival group,with statistical significance(P＜0.05).Logistic regression a-nalysis revealed that age(OR=1.227),ISS score(OR=1.549),shock(OR=3.640),blood glucose(OR=2.757),and 24 h IPC(OR=0.029)were independently associated with death within 7 days(P＜0.05).RCS anal-ysis showed a significant linear relationship between 24 h IPC and the risk of death in patients with multiple inju-ries(nonlinear test P=0.478).Patients with delayed-onset MODS had higher IPC levels at 7 days after admission compared to those with early-onset MODS and those without MODS,and patients with delayed-onset VTE had higher IPC levels at 7 days after admission compared to those with early-onset VTE and those without VTE,with statistically significant differences(P＜0.05).Conclusion:Lower levels of immature platelets during the acute phase in patients with multiple injuries are associated with increased mortality,while higher levels of immature platelets at later stages may trigger MODS and VTE.
multiple injuriesneonatal plateletsmortalitymultiple organ dysfunction syndromevenous thrombosis
NETL
NSTL
万方数据
