| Backgrounds and objections:With the development of medical research in recent years, it was found between inflammation and thrombosis there are mutually reinforcing.Platelet activation leads to inflammation in the body causing hypercoagulable state, at the same time, extensive micro-thrombus formation can also lead to some products and increase the inflammatory response. Inflammatory reaction amplification and micro-thrombosis can not be separated platelet activation, so platelet reciprocal causation is the key component of the process. The paper by retrospectively analyzed 336 cases of critically ill patients platelet count, mean platelet volume and platelet distribution width changes in parameters of platelet-related relationship with critical illness, further elaboration of platelet-related parameters and severity of critical illness, died rate of correlation, and then guide the clinical work, early effective treatment to take measures to improve the prognosis of critically ill patients and reduce mortality.Research Methods:336 cases of critically ill patients admitted to our hospital from february in 2009 to february in 2011, male:169 cases, female: 167cases, age 17～106 years, mean age 59.5±15.4 Years.Exclude cases with a history of major blood loss before admission, cases with blood diseases (such as:idiopathic thrombocytopenic purpura, aplastic anemia), cases with extreme consumption for cancer, cases with cirrhosis of the liver, cases for a variety of needs antiplatelet, anticoagulant drugs before admission, cases with application of platelet transfusion or had been liter-platelet drugs pre-hospital or short-term, cases with poor compliance who can not cope with the examination and treatment. In accordance with APACHEⅡscore results which have been calculated at the worest value of auxiliary examination on day 1 of ICU, patients were divided into 3 groups:A group (APACHEⅡscore<10 156 cases), B group (APACHEⅡscore 11-19 109 cases), C group (APACHEⅡscore> 20 71 cases). Collect admission history, physical examination and various additional tests, mainly including patient age, history of chronic diseases and the body temperature, respiratory rate, heart rate, mean arterial pressure, arterial oxygen saturation, alveolar arterial oxygen,pH, potassium, blood Sodium, serum creatinine, hematocrit, white blood cell count, Glasgow score, platelet count, mean platelet volume, platelet distribution width and treatment results(who transferred out of ICU or discharged are live;who died or with abandonment of treatment and rescue during hospitalization in ICU) within 24 hours and the day on which patients transferred out of ICU or discharged or died. Statistic platelet count, mean platelet volume and platelet distribution width and the difference in mortality of A,B,C group with application of statistical software. Meanwhile, In accordance with parameters of platelet and treatment patients were divided into a,b,c,d group:a group: patients with one or more abnormal platelet-related parameters and died finally,58 cases;b group:patients with one or more abnormal platelet-related parameters and good prognosis finally,82 cases;c group:patients with all normal platelet-related parameters and died finally,31cases;d group:patients with all normal platelet-related parameters and good prognosis finally,165 cases. Statistic APACHEⅡ, platelet count, mean platelet volume and platelet distribution width of patients within 24 hours and the day on which patients transferred out of ICU or discharged or died.Results:1. Disease severity and disease prognosis:A group:Survival 139 cases;death 17 cases, mortality 10.9%; B group:Survival 74 cases, death 35 cases, mortality 32.1%; C group:survival 34 cases, death37 cases, mortality 52.1%. Mortality between the groups are significantly different.The higher APACHEⅡscore, the more severe disease, mortality is higher.2. The relationship between severity of the disease and platelet-related parameters:A group:platelet count 159±42×109/L, mean platelet volume 7.3±2.2 fl, platelet distribution width 15.3±3.1%, B group:platelet count 126±36×109/L, mean platelet volume 8.5±2.1 fl, platelet distribution width 16.4±2.9%, C group:platelet count 96±32×109/L, mean platelet volume 9.9±2.3 fl, platelet distribution width 17.6±3.5%. Statistic of platelet count, mean platelet volume, platelet distribution width of A, B, C group is significantly different (P<0.05). With the rise of APACHEⅡscore, platelet count is decreased; mean platelet volume and platelet distribution width is increased.3. The relationship between platelet-related parameters and the process of disease:patients of a group:when came in to ICU APACHEⅡ19.5±3.2, platelet count 94±30×109/L, mean platelet volume 9.8±2.1fl, platelet distribution width 17.4±2.9%, when died APACHEⅡ24.3±3.1, platelet count 49±21×109/L mean platelet volume 11.1±2.5fl, platelet distribution width 18.5±2.8%. The day of their death compared with the day into ICU, statistic of APACHEⅡ,platelet count, mean platelet volume, platelet distribution width is significantly different (P<0.05); Patients of b group:when came in to ICU APACHEⅢ7.8±2.9, platelet count 97±30×109/L, mean platelet volume 9.3±1.9fl, platelet distribution width 16.5±2.5%, when got out of ICU APACHEⅡ8.9±2.1, platelet count 152±35×109/L, mean platelet volume 7.4±1.8fl, platelet distribution width 15.1±1.9%. The day of out of ICU compared with the day into ICU, statistic of APACHEⅡ,platelet count, mean platelet volume, platelet distribution width is significantly different (P <0.05);Patients of c group:when came in to ICU APACHEⅡ16.7±2.7, platelet count 125±26×109/L, mean platelet volume 8.9±2.1fl, platelet distribution width 15.3±1.8%, when died APACHEⅡ22.6±3.3, platelet count 79±28×109/L, mean platelet volume 10.8±2.4fl, platelet distribution width17.6±2.3%. The day of their death compared with the day into ICU,, statistic of APACHEⅡ,platelet count, mean platelet volume, platelet distribution width is significantly different (P<0.05); Patients of d group:when came in to ICU APACHEⅡ12.7±2.7, platelet count 137Ⅱ37×109/L, mean platelet volume 8.5±2.9fl, platelet distribution width 15.7±1.8%, when got out of ICU APACHEⅡ8.1±2.0, platelet count 167±41×109/L, mean platelet volume 8.3±2.5fl, platelet distribution width 15.4±1.9%. The day of out of ICU compared with the day into ICU, statistic of APACHEⅡand platelet count is significantly different (P<0.05), statistic of mean platelet volume and platelet distribution width is not significantly different(P>0.05). Above suggest that changes as the disease severity, platelet-related parameters also change accordingly.Conclusions:1. With the increase of disease severity and the rise of APACHEⅡscore, platelet count is significantly decreased; mean platelet volume and platelet distribution width is significantly increased and mortality is significantly increased.2. There is a significant correlation between platelet count, mean platelet volume and platelet distribution width in the prognosis of critically illness. The less platelet count and the more platelet volume and platelet distribution width is, the more severe illness is, the worse prognosis is, on the contrary, the better prognosis is. |
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