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目的研究多器官功能障碍综合征(MODS)病人发生血小板缺乏的危险因素及其对预后的影响。方法对5家教学医院加强医疗病房(ICU)中1年内收治的366例MODS病人进行回顾性分析。记录病人的人口统计学资料、临床信息、急性生理和慢性健康评分(APACHEⅡ)及序贯性器官衰竭评分(SOFA)。主要研究终点为住院病死率。结果住院期间共有151例病人死亡(41·3%)。血小板缺乏P=0·022,OR(比数比)=2·143,可信限(95%CI)1·114~4·121,神经系统衰竭(P<0·01,OR=6·033,95%CI3·164~11·506)和最高SOFA评分(P<0·01,OR=1·215,95%CI1·112~1·328),是预后的独立危险因素。共有220例MODS病人(60·1%)发生血小板缺乏。ICU住院时间(P=0·023,OR=1·017,95%CI1·002~1·032)和最高SOFA评分(P<0·01,OR=1·271,95%CI1·187~1·361)是发生血小板缺乏的独立危险因素,而最高SOFA评分(P<0·01,OR=1·405,95%CI1·276~1·548)和继发性血小板缺乏(P<0·01,OR=3·517,95%CI1·780~6·951)是伴有血小板缺乏的MODS病人死亡的独立危险因素。结论血小板缺乏在MODS病人中非常普遍,并导致住院病死率升高。
Objective To study the risk factors of thrombocytopenia in patients with multiple organ dysfunction syndrome (MODS) and its effect on prognosis. Methods A retrospective analysis was performed on 366 patients with MODS who were treated in 1 intensive care unit (ICU) in 5 teaching hospitals. Patient demographics, clinical information, acute physiology and chronic health score (APACHE II), and sequential organ failure score (SOFA) were recorded. The primary endpoint was in-hospital mortality. Results A total of 151 patients died during hospitalization (41.3%). P = 0.022, OR (odds ratio) = 2.143, confidence limit (95% CI) ranged from 114 to 4.121, nervous system failure (P <0.01, OR = 6.033 , 95% CI3 · 164 ~ 11 · 506) and the highest SOFA score (P <0.01, OR = 1.155, 95% CI1 · 112-1.328) were independent risk factors for prognosis. A total of 220 MODS patients (60 · 1%) suffered from a lack of platelets. ICU length of hospital stay (P = .0223, OR = 1.175, 95% CI1.002-1.032) and highest SOFA scores (P <0.01, OR = 1.27, 95% CI1.18-1 · 361) was an independent risk factor for thrombocytopenia, with the highest SOFA scores (P <0.01, OR = 1.45, 95% CI 1.276-1.548) and secondary thrombocytopenia 01, OR = 3.17, 95% CI1.780-6.5951) were independent risk factors for death in MODS with thrombocytopenia. Conclusion Platelet deficiency is very common in MODS patients and leads to an increased in-hospital mortality.