天津医药

天津医药 ›› 2020, Vol. 48 ›› Issue (4): 279-283.doi: 10.11958/20193076

• 临床研究 • 上一篇    下一篇

早期血小板变化对重症中暑患者28 d死亡的预测价值 #br#

李亚杰 1，俞建峰 2△，周仪 2，杨巧云 2，朱琦莲 2，李永畅 2
  

  1. 1南京医科大学附属常州第二人民医院急诊科（邮编 213003），2重症医学科
  • 收稿日期:2019-10-16 修回日期:2020-01-10 出版日期:2020-04-15 发布日期:2020-06-23
  • 通讯作者: 俞建峰 E-mail:275871455@qq.com
  • 作者简介:李亚杰（1984）男，硕士，主治医师，主要从事重症神经及百草枯中毒的诊疗方面研究
  • 基金资助:
    江苏省卫生计生委 2016年度面上科研课题（H201651）

Predictive values of early changes of platelet in 28-day mortality of patients with#br# severe heat stroke #br#

LI Ya-jie1, YU Jian-feng2△, ZHOU Yi2, YANG Qiao-yun2, ZHU Qi-lian2, LI Yong-chang2   

  1. 1 Department of Emergency, 2 Department of Intensive Care Unit, the Affiliated Hospital of Nanjing Medical University,
    Changzhou No. 2 People    ’s Hospital, Changzhou 213003, China
  • Received:2019-10-16 Revised:2020-01-10 Published:2020-04-15 Online:2020-06-23
  • Contact: YU Jian-feng E-mail:275871455@qq.com

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摘要： 目的 探讨早期血小板变化对重症中暑患者 28 d 预后的预测价值。方法 回顾性分析 2010 年 9 月—
2018年 9月常州市第二人民医院收治的重症中暑患者，根据 28 d预后将重症中暑患者分为存活组和死亡组。收集患
者基本资料，入院时、入院 72 h 血小板计数（PLT0、PLT72），以 PLT0、PLT72、血小板变化值（ΔPLT）、血小板变化率
（ΔPLT%）及急性生理与慢性健康（APACHEⅡ）评分绘制受试者工作特征（ROC）曲线，评估其对 28 d预后的预测价
值。分别以重症中暑患者 PLT0、PLT72和 ΔPLT%的临界值将患者分组，采用 Kaplan-Meier生存曲线分析患者 28 d累
积存活率。结果 （1）共纳入 116例重症中暑患者，存活组 90例，死亡组 26例，病死率 22.4%。死亡组使用血管活性
药物比例、有创机械通气比例及 APACHEⅡ评分明显高于存活组（P＜0.05）。（2）2组血小板计数均呈现下降趋势，死
亡组 PLT0、PLT72均明显低于存活组（均 P＜0.05），同时死亡组 ΔPLT 和 ΔPLT%下降幅度大于存活组（P＜0.05）。（3）
ROC曲线分析显示，APACHEⅡ评分、PLT0、PLT72及 ΔPLT%对重症中暑患者 28 d死亡均有较好的预测价值，相应预测
临界值分别为 PLT0＞115.0×109/L，PLT72＞83.5×109/L，ΔPLT%＞-41.6%，其中以 PLT72的 ROC 曲线下面积（AUC）最
大，为 0.841（P＜0.05）。（4）Kaplan-Meier生存曲线分析显示，以 PLT0、PLT72及 ΔPLT%相应的临界值分组，高于相应临界值患者 28 d存活率明显高于低于相应临界值者（P＜0.05）。结论 入院 72 h PLT对重症中暑患者预后具有较好的
预测价值，入院早期 PLT显著下降提示重症中暑患者预后不良。

关键词: 血小板计数, 重症中暑, 死亡, 预测价值

Abstract: Objective To explore the predictive value of early changes of platelet in the evaluation of 28-day prognosis
in the patients with severe heat stroke. Methods A retrospective study was conducted. The patients with severe heat stroke
admitted to the Second People’s Hospital of Changzhou from September 2010 to September 2018 were enrolled. These
patients were divided into survival group and death group according to 28-day outcome. The general condition and platelet
counting at 0 (PLT0), 72 hours (PLT72) after admission were collected. Receiver operating characteristic curve (ROC) was
plotted according to the platelet counting, the changes of platelet (ΔPLT), the change rates of platelet (ΔPLT%) and acute
physiology and chronic health status score (APACHEⅡ) for evaluating the predictive value of 28-day prognosis. KaplanMeier survival curve was used to analyze the 28-day cumulative survival rate between two groups of patients, who were subdivided according to the PLT0, PLT72, ΔPLT% and APACHEⅡ scores. Results (1) A total of 116 patients with severe heat stroke were enrolled in this study, including 90 cases in the survival group and 26 cases in the death group. The mortality was 22.4%. The rate of using vasoactive drugs, the length of invasive mechanical ventilation and APACHE Ⅱ scores were significantly higher in the death group than those in the survival group (P＜0.05). (2) The platelet levels showed the downward trend in both groups. Values of PLT0 and PLT72 were significantly lower in the death group than those in the survival group (P＜0.05). Meanwhile, the decrease ranges of ΔPLT and ΔPLT% were significantly larger in the death group  than those in the survival group (P＜0.05). (3) ROC curve analysis showed that values of APACHEⅡ scores, the PLT0, PLT72
and ΔPLT% could predict 28-day mortality in the patients with severe heat stroke, with the largest area under ROC curve
0.841 of PLT
72 (P＜0.05). (4) Kaplan-Meier survival analysis showed that the 28-day survival rate was significantly higher
than the cut-off value when the PLT
0 and PLT72 were higher (both P＜0.05). Conclusion The PLT at 72 hours after
admission may play an important role in predicting prognosis of the patients with severe heat stroke, The continuous decline
of PLT indicates poor prognosis in patients with severe heat stroke.

Key words: platelet count, severe heart stroke, death, prognosis

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