膿毒癥相關(guān)血小板減少癥課件

相子血小標(biāo)浦小絲△相子血小標(biāo)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(shù)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(chǎn)生不足,脾臟對(duì)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(yán)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(xiàn)月經(jīng)血量多、血尿等。皮膚上可出現(xiàn)大小不等的出血點(diǎn)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(dá)79.6越來越多的研究證實(shí),血小板是介導(dǎo)嚴(yán)重膿毒癥患兒凝血和炎癥反應(yīng)的關(guān)鍵因素,是聯(lián)系內(nèi)源性和獲得性免疫應(yīng)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(nèi)皮細(xì)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(shí)基本免疫反應(yīng)途徑PatternrecognitioJProtease-activatedreceptorsCytokineLPS(andothermicrobialmediatorsKininsCompleterMonocyteInflammationCoagulationAbbreviations:TF,tissuefactor,PAF,plateletactivatingfactor:NO,nitricoxide膿毒癥時(shí)基本免疫反應(yīng)途徑8大于00血小板圖1不同血小板計(jì)數(shù)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(jì)數(shù)與APACHEII評(píng)分的關(guān)系r=0117P<0100110膿毒癥相關(guān)血小板減少癥課件11膿毒癥相關(guān)血小板減少癥課件12膿毒癥相關(guān)血小板減少癥課件13膿毒癥相關(guān)血小板減少癥課件14膿毒癥相關(guān)血小板減少癥課件15膿毒癥相關(guān)血小板減少癥課件16膿毒癥相關(guān)血小板減少癥課件17膿毒癥相關(guān)血小板減少癥課件18膿毒癥相關(guān)血小板減少癥課件19膿毒癥相關(guān)血小板減少癥課件20膿毒癥相關(guān)血小板減少癥課件21膿毒癥相關(guān)血小板減少癥課件22膿毒癥相關(guān)血小板減少癥課件23膿毒癥相關(guān)血小板減少癥課件24膿毒癥相關(guān)血小板減少癥課件25膿毒癥相關(guān)血小板減少癥課件26膿毒癥相關(guān)血小板減少癥課件27膿毒癥相關(guān)血小板減少癥課件28膿毒癥相關(guān)血小板減少癥課件29膿毒癥相關(guān)血小板減少癥課件30膿毒癥相關(guān)血