膿毒癥相關血小板減少癥課件

相子血小標浦小絲△相子血小標浦小絲△1血小板減少癥(Thrombocytopenia)概述血小板減少癥(Thrombocytopenia)是指血小板記數低于正常范圍所引起的病癥。血小板減少癥分類:繼發(fā)性血小板減少癥和特發(fā)性血小板減少癥。血小板減少癥的原因可能源于血小板產生不足,脾臟對血小板的阻留,血小板破壞或利用增加以及被血液被稀釋無論何種原因所致的嚴重血小板減少,都可引起典型的出血血小板減少癥(Thrombocytopenia)概述2IC∪患者血小板減少的因素pseudo-thrombocytopeniaEHm少HemodilutionIncreasedplateletn3ANBiDk(baterarmis,fungearnisnsfusionofredbloodconsumptiona,burns,shock,infection,obstetricalcoislivercirrhosis,moticmienovasculardisordersIIncreasedplateletdestructiontransfusionpurpura'plateletalloantbodiesDecreasedplateletproductionisease/Chronicalcoholabuzawithfolatadeficiencyer式temcellstranIncreasedplateletHrpersplsnism.HsposequestrationGreinacheraellerKHematologyAmSoeHermatdlEducProgram.2019135-143.IC∪患者血小板減少的因素3血小板減少的癥狀血小板減少可以引起一系列癥狀如如鼻出血,牙齦出血,口腔粘Petechiae膜出血,胃腸道也可出血、還可出現月經血量多、血尿等。皮膚上可出現大小不等的出血點或淤斑,多見于四肢,以下肢最常見稱為“紫癜血小板減少的癥狀4ICU病人的血小板減少癥(Thrombocytopenia17.3%膿毒癥病人7.582.7%92.5%非膿毒癥病人ICU病人的血小板減少癥(Thrombocytopenia5·研究表明35%‰-59%的膿毒癥患者可發(fā)生血小板減少,血培養(yǎng)陽性的患者血小板下降的發(fā)生率高達79.6越來越多的研究證實,血小板是介導嚴重膿毒癥患兒凝血和炎癥反應的關鍵因素,是聯系內源性和獲得性免疫應答的橋梁,膿毒癥發(fā)病過程中的多種因素促發(fā)血小板與內皮細胞的相互作用。GunterOLJr,AuBK,IsbellJM,etal.Optimizingoutcomesindamagecontrolresuscitationidentifyingbloodproductratiosassociatedwithimprovedsurvival.JTrauma,2019,65(3:527-534·研究表明35%‰-59%的膿毒癥患者可發(fā)生血小板減少,血6Incaseofsystemicinflammatorysyndromes,suchastheresponsetosepsis,disseminatedintravascularplateletactivationmayoccur,whichwillcontributetomicrovascularfailureandtherebyplayaroleinthedevelopmentoforgandysfunction.Alowplateletcountisastrongandindependentpredictorofanadverseoutcomeincriticallyillpatients,therebyfacilitatingasimpleandpracticalriskassessmentinthesepatientsandpotentiallyguidingtheuseofcomplexorexpensivetreatmentstrateglesMarcelLevi,EsterC.LowenbergThrombocytopeniainCriticallyIllPatients.SeminThrombHemost.2019.34(5:417-424Incaseofsystemicinflammato7膿毒癥時基本免疫反應途徑PatternrecognitioJProtease-activatedreceptorsCytokineLPS(andothermicrobialmediatorsKininsCompleterMonocyteInflammationCoagulationAbbreviations:TF,tissuefactor,PAF,plateletactivatingfactor:NO,nitricoxide膿毒癥時基本免疫反應途徑8大于00血小板圖1不同血小板計數的腹腔感染病人的病死率大于009r=0117P<01001204油翻ZHILIHIMEDIANIPLHILHLALLI圖2血小板計數與APACHEII評分的關系r=0117P<0100110膿毒癥相關血小板減少癥課件11膿毒癥相關血小板減少癥課件12膿毒癥相關血小板減少癥課件13膿毒癥相關血小板減少癥課件14膿毒癥相關血小板減少癥課件15膿毒癥相關血小板減少癥課件16膿毒癥相關血小板減少癥課件17膿毒癥相關血小板減少癥課件18膿毒癥相關血小板減少癥課件19膿毒癥相關血小板減少癥課件20膿毒癥相關血小板減少癥課件21膿毒癥相關血小板減少癥課件22膿毒癥相關血小板減少癥課件23膿毒癥相關血小板減少癥課件24膿毒癥相關血小板減少癥課件25膿毒癥相關血小板減少癥課件26膿毒癥相關血小板減少癥課件27膿毒癥相關血小板減少癥課件28膿毒癥相關血小板減少癥課件29膿毒癥相關血小板減少癥課件30膿毒癥相關血