单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,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,2,IC患者血小板减少的因素,pseudo-,thrombocy to penia,EHm少,Hemodilution,Increased platelet n3 A N BiD k(b at er armis,fungearnis,nsfusion of red blood,consump tion,a,burns,shock,infe ction,ob st et rical co,is liver cirrho sis,m,oticmienovascula r d iso rders,I Increased platelet,destruction,transfusion purpurap lat elet allo ant bodies,Decreased platelet,production,isease/Chron ic al cohol abuza with folat a deficiency,er式 tem cellstran,Increased platelet Hrp ersplsnism.Hspo,seq uestration,Greinacher a eller K Hematology Am Soe Hermatdl Educ Program.2019 135-143.,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,4,ICU病人的血小板减少症(Thrombocytopenia,17.3%,脓毒症病人,7.5,82.7%,92.5%,非脓毒症病人,ICU病人的血小板减少症(Thrombocytopenia,5,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。,Gunter OL Jr,Au BK,Isbell JM,et al.Optimizing outcomes in damage,control resuscitation identifying blood product ratios associated with,improved survival.J Trauma,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,6,In case of systemic inflammatory syndromes,such as th,e response to sepsis,disseminated intravascular platele,t activation may occur,which will contribute to microva,scular failure and thereby play a role in the developme,nt of organ dysfunction.A low platelet count is a stron,g and independent predictor of an adverse outcome in,critically ill patients,thereby facilitating a simple and pr,actical risk assessment in these patients and potentially,guiding the use of complex or expensive treatment str,ategles,Marcel Levi,Ester C.Lowenberg Thrombocytopenia in Critically Ill,Patients.Semin Thromb Hemost.2019.34(5:417-424,In case of systemic inflammato,7,脓毒症时基本免疫反应途径,Pattern recognitio,J Protease-activated receptors,Cytokine,LPS(and other microbial mediators,Kinins,Completer,Monocyte,Inflammation,Coagulation,Abbreviations:TF,tissue factor,PAF,platelet activating factor:NO,nitric oxide,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00,9,r=0117P01001,204,油翻,ZHI,LIH,I,MEDIANIPLHILHLALLI,图2血小板计数与 APACHE II评分的关系,r=0117P01001,10,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,脓毒症相关血小板减少症课件,31,脓毒症相关血小板减少症课件,32,脓毒症相关血小板减少症课件,33,脓毒症相关血小板减少症课件,34,脓毒症相关血小板减少症课件,35,脓毒症相关血小板减少症课件,36,脓毒症相关血小板减少症课件,37,脓毒症相关血小板减少症课件,38,脓毒症相关血小板减少症课件,39,