脓毒症相关血小板减少症课件

相子血小标浦小丝△相子血小标浦小丝△1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血小板减少症(Thrombocytopenia)概述2IC∪患者血小板减少的因素pseudo-thrombocytopeniaEHm少HemodilutionIncreasedplateletn3ANBiDk(baterarmis,fungearnisnsfusionofredbloodconsumptiona,burns,shock,infection,obstetricalcoislivercirrhosis,moticmienovasculardisordersIIncreasedplateletdestructiontransfusionpurpura'plateletalloantbodiesDecreasedplateletproductionisease/Chronicalcoholabuzawithfolatadeficiencyer式temcellstranIncreasedplateletHrpersplsnism.HsposequestrationGreinacheraellerKHematologyAmSoeHermatdlEducProgram.2019135-143.IC∪患者血小板减少的因素3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“紫癜血小板减少的症状4ICU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ICU病人的血小板减少症(Thrombocytopenia5·研究表明35%‰-59%的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。GunterOLJr,AuBK,IsbellJM,etal.Optimizingoutcomesindamagecontrolresuscitationidentifyingbloodproductratiosassociatedwithimprovedsurvival.JTrauma,2019,65(3:527-534·研究表明35%‰-59%的脓毒症患者可发生血小板减少,血6Incaseofsystemicinflammatorysyndromes,suchastheresponsetosepsis,disseminatedintravascularplateletactivationmayoccur,whichwillcontributetomicrovascularfailureandtherebyplayaroleinthedevelopmentoforgandysfunction.Alowplateletcountisastrongandindependentpredictorofanadverseoutcomeincriticallyillpatients,therebyfacilitatingasimpleandpracticalriskassessmentinthesepatientsandpotentiallyguidingtheuseofcomplexorexpensivetreatmentstrateglesMarcelLevi,EsterC.LowenbergThrombocytopeniainCriticallyIllPatients.SeminThrombHemost.2019.34(5:417-424Incaseofsystemicinflammato7脓毒症时基本免疫反应途径PatternrecognitioJProtease-activatedreceptorsCytokineLPS(andothermicrobialmediatorsKininsCompleterMonocyteInflammationCoagulationAbbreviations:TF,tissuefactor,PAF,plateletactivatingfactor:NO,nitricoxide脓毒症时基本免疫反应途径8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大于009r=0117P<01001204油翻ZHILIHIMEDIANIPLHILHLALLI图2血小板计数与APACHEII评分的关系r=0117P<0100110脓毒症相关血小板减少症课件11脓毒症相关血小板减少症课件12脓毒症相关血小板减少症课件13脓毒症相关血小板减少症课件14脓毒症相关血小板减少症课件15脓毒症相关血小板减少症课件16脓毒症相关血小板减少症课件17脓毒症相关血小板减少症课件18脓毒症相关血小板减少症课件19脓毒症相关血小板减少症课件20脓毒症相关血小板减少症课件21脓毒症相关血小板减少症课件22脓毒症相关血小板减少症课件23脓毒症相关血小板减少症课件24脓毒症相关血小板减少症课件25脓毒症相关血小板减少症课件26脓毒症相关血小板减少症课件27脓毒症相关血小板减少症课件28脓毒症相关血小板减少症课件29脓毒症相关血小板减少症课件30脓毒症相关血