重度血小板减少门脉高压症脾切除术中预防性输注血小板疗效及输注时机的探讨  

Effect of prophylactic platelet transfusion in the splenectomy of severe thrombocytopenia in patients with portal hypertension and study on the timing of infusion

作　　者：任广辉 丁海[1] 刘俊卯[1] 吴作友[1] 

机构地区：[1]东南大学附属第二医院肝胆外科,南京210003

出　　处：《疑难病杂志》2017年第11期1109-1112,共4页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的探讨围手术期预防性输注血小板在重度血小板减少肝硬化门脉高压症脾切除术中的治疗效果及不同输注时间的效果比较。方法选取2013年8月—2016年8月东南大学附属第二医院肝胆外科行脾切除联合贲门周围血管离断术的62例患者,术前血小板计数≤30×10~9/L,均为重度血小板减少肝硬化门脉高压症患者,依据围手术期是否预防性输注血小板及输注时间的不同分为3组,对照组(20例)围手术期未预防性输注血小板,治疗Ⅰ组(22例)于切开皮肤前开始输注单采血小板1个治疗量,治疗Ⅱ组(20例)于脾脏切除后开始输注单采血小板1个治疗量比较3组在术中出血量、术后48 h引流总量、术后出血发生率及术后血小板的变化情况。结果 2个治疗组术中出血量、术后48 h引流总量及术后出血发生率均较对照组低(治疗Ⅰ组:t=3.459、3.935,X^2=4.772,P<0.05;治疗Ⅱ组:t=3.347、4.148,X^2=5.584,P<0.05),治疗Ⅰ组与治疗Ⅱ组比较差异无统计学意义(P>0.05)。治疗组输注后1h、24 h血小板计数较对照组回升明显,差异有统计学意义(输注后1h:t=4.306、8.464,P<0.05;输注后24 h:t=4.239、5.767,P<0.05),治疗Ⅱ组输注后1h血小板计数较治疗Ⅰ组高(t=3.272,P<0.01);治疗Ⅱ组输注血小板后1 h、24 h CCI、PPR值明显高于治疗Ⅰ组,差异有统计学意义(P<0.01),且输注后1 h、24 h有效率高于治疗Ⅰ组,其中输注后1h有效率比较差异有统计学意义(85.00%vs.54.55%,X^2=4.546,P<0.05)。结论对血小板计数≤30×10~9/L的重度血小板减少肝硬化门脉高压症行脾切除联合贲门周围血管离断术的患者,围手术期预防性输注血小板可减少术中出血量、术后引流量,并可在短时间内提升血小板水平,且在脾切除后开始输注可减少血小板的破坏,进一步提高疗效。Objective To estimate the efficacy of prophylactic platelet transfusion in the preoperative preparation of severe thrombocytopenia in patients with portal hypertension and difference of different infusion time. Methods Sixty two patients of preoperative platelet count less than 30×10~9/L of severe thrombocytopenia in patients with liver cirrhosis and portal hypertension, according to the perioperative prophylactic platelet transfusion and infusion time, all patients were divided into three groups, the control group were patients(20 cases) without prophylactic platelet transfusions during the perioperative period, in the treatment group I(22 cases), one therapeutic doses of platelets were transfused before the incision,while in the treatment group 2(20 cases),one therapeutic doses of platelets were transfused after splenectomy. Intraoperative bleeding volume, 48 hours of drainage, postoperative bleeding rate and the changes of platelet after operation were observed and recorded.Results The treatment group of intraoperative bleeding, postoperative 48 hours total drainage and postoperative bleeding rate was lower than the control group(group 1: t =3.459, t =3.935,X^2=4.772; group 2: t =3.347, t =4. 148,X^2 = 5.584,P < 0.05), and between the two treatment groups had no statistically significant difference( P >0.05); the treatment group1 h and 24 h after infusion, the platelet count were significantly higher than those in the control group(after 1 h: t =4. 306,t = 8.464; after 24 h: t =4.239, t =5.767; P <0.05), treatment group 2 was higher than that in the treatment 1 group(after 1 h: t =3.273, P <0.05), and 1 h, 24 h after infusion, the efficiency was higher than that of treatment group 1, and1 h after infusion rate difference was statistically significant(85.00% vs. 54. 55%, X^2 =4. 546, P < 0. 05). Conclusion The platelet count is less than 30 ×10~9/L of severe thrombocytopenia in patients with cirrhosis and portal hypertension splenectomy combined with pericardial devascularization, perioperative prophylactic p

关 键 词：血小板减少 门脉高压症 围手术期处理 输注血小板 预防性 

分 类 号：R657.34[医药卫生—外科学]