【原】【罂粟摘要】创伤性脑损伤术后血小板减少与预后的相关性：一项队列研究

创伤性脑损伤术后血小板减少与预后的相关性：一项队列研究

贵州医科大学   麻醉与心脏电生理课题组

翻译：马艳燕   编辑：严旭   审校：曹莹

背景：众所周知，创伤性脑损伤(TBI)患者常发生血小板减少症，其发病率随着损伤的严重程度而增加。我们旨在确定TBI患者术后血小板减少症是否与不良的临床结局相关。

方法：这是一项大型国际数据库的回顾性队列研究，名为重症监护医疗信息市场III（MIMIC-III），其中包括1093名接受TBI手术的患者。住院死亡率是本研究的主要结局指标。

结果：多因素logistic回归分析显示，非血小板减少症与住院死亡率降低显著相关（校正优势比[OR] 0.49;95% 置信区间 [CI] 0.33–0.75;p =0.01）。此外，根据广义相加混合模型（GAMM），存活和死亡患者的血小板计数随着时间的推移而增加。然而，存活组的血小板计数比死亡组更明显地增加，两组之间的血小板计数差异在手术后7天内呈增加趋势。这种差异平均每天增加7.97。

结论：术后出现血小板减少症的TBI患者近期预后较差。此外，我们发现存活组和死亡组之间的血小板生长率随时间变化有显著差异。早期血小板计数增加较多的TBI患者死亡率较低。

原始文献来源：

Xu J, Zhu Y, Zhen S, Jiang X. Association between postoperative thrombocytopenia and outcomes after traumatic brain injury surgery: A cohort study. Acta Anaesthesiol Scand. 2023 Apr 7. doi: 10.1111/aas.14244. 

英文原文：

Association between postoperative thrombocytopenia and outcomes after traumatic brain injury surgery: A cohort study

Background: It is well known that thrombocytopenia occurs in patients with traumatic brain injury (TBI), and its incidence increases with the severity of injury. We aimed to determine whether postoperative thrombocytopenia in patients with TBI is associated with poor clinical outcomes.

Methods: This was a retrospective cohort study of a large international database called the Medical Information Mart for Intensive Care III (MIMIC-III), which included 1093 patients who underwent TBI surgery. Hospital mortality was the primary endpoint of this study.

Results: Multivariate logistic regression analysis revealed non-thrombocytopenia was significantly associated with a decreased hospital mortality (adjusted odds ratio [OR] 0.49; 95% confidence interval [CI] 0.33–0.75; p = .01). In addition, platelet counts increased over time in both survivors and non-survivors, according to generalized additive mixed model (GAMM). However, the platelet count increased more noticeably in the survivors than in the non-survivors and the difference in platelet count between the two groups showed a trend toward increasing within 7 days after surgery. This difference increased by 7.97 per day on average.

Conclusions: Patients with TBI who experienced postoperative thrombocytopenia were more likely to have a poor short-term prognosis. In addition, we found that the rate of platelet growth over time varied significantly between the survival and non-survival groups. Patients with TBI who experienced a greater early increase in platelet count had a lower mortality rate.