41例血友病患儿合并外科疾病的围手术期治疗回顾  

Retrospective study on management of the perioperative period in 41 cases of hemophilic children with surgical diseases

作　　者：王雪[1] 蔡金晶 陈其民[1] 陈静[1] 褚珺[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心小儿外科,上海200127

出　　处：《国际外科学杂志》2015年第1期36-39,共4页International Journal of Surgery

摘　　要：目的 探讨血友病患儿合并外科疾病时围手术期血液替代以及术后并发症的应对策略.方法 本中心回顾性分析自2003-2013年10年来41例合并外科疾病的血友病患儿的围手术处理方法.41例患儿中甲型血友病33例（其中重型10例、中型13例、轻型8例,亚临床型2例）,乙型血友病8例,重型2例,轻型6例,均需行不同类型手术.结果 通过凝血因子VⅢ（FVⅢ）、凝血酶原复合物（PPSB）以及新鲜冰冻血浆等血液替代疗法,术前、术后对患儿血液中血小板计数、PT、APTT等指标监测,38例患儿顺利手术,未出现外科并发症.1例患儿死亡,1例患儿术后腹腔出血,1例患儿伤口愈合延迟.结论 术前充分准备和周密计划,术中、术后正确实施血液替代疗法,可有效降低血友病术后出血并发症.Objective To discuss the blood substitutes during the perioperative period for hemophilic children with surgical disease as well as the coping strategies to its postoperative complications.Methods A retrospective study between 2003 and 2013 from one our centre identified a total of 41 perations performed in haemophiliac patients.33 patients were diagnosed with haemophilia A,among whom 10 were severe cases,13 moderate cases and 8 mild cases.8 patients were diagnosed with haemophilia B,among whom 2 were severe cases and 6 were mild cases.Different kinds of operation were required for each case.Results According to the monitoring of the coagulation tests PT and APTT before and after the operation respectively,after the use of the blood substitutes such as FV Ⅲ,PPSB and fresh frozen plasma,38 patients underwent surgical treatment successfully and had full recovery without any surgical complications,1 patient was dead,1 suffered intraperitoneal hemorrhage and 1 had delayed wound healing.Conclusion Full preparation and thorough plan before the operations,combined with appropriate blood substitutes can effectively reduce postoperative bleeding for hemophilic children.

关 键 词：血友病A 围手术期医护 替代治疗 

分 类 号：R554.1[医药卫生—血液循环系统疾病]