大剂量单次输注血小板在激素不敏感型卡梅现象患儿术前的应用  

Perioperative platelet transfusion in infantile with Kasabach-Merritt phenomenon insensitive toglucocorticoids

作　　者：郭晓楠[1] 朱晓爽[1] 刘大看[1] 龚毓宾 雷红召[1] 董长宪[1] Guo Xiaonan;Zhu Xiaoshuang;Liu Dakan;Gong Yubin;Lei Hongzhao;Dong Changxian(Department of Hemangioma ＆ Vascular Malformation, Henan Provincial People＇s Hospital, Zhengzhou 450003, Chin)

机构地区：[1]河南省人民医院血管瘤科,郑州450003

出　　处：《中华整形外科杂志》2018年第5期356-359,共4页Chinese Journal of Plastic Surgery

基　　金：河南省科技厅科技攻关项目（142102310080）

摘　　要：目的探讨大剂量单次输注血小板在激素不敏感型卡梅现象患儿术前应用的安全性和有效性。方法对2011年5月至2016年12月收治的激素不敏感型卡梅现象患儿，术前输注血小板的方式、效果进行总结和评估。血小板输注方法：根据患者血小板数值，于术前12-24 h大剂量单次输注血小板，血小板计数（PLTC）〈30×10^9/L者以0.3个治疗量/kg输注，PLTC≥30×10^9/L者以0.2个治疗量/kg输注，最大总量均不超过1个治疗量。血小板输注效果判定：输注血小板后1 h，PLTC上升至≥100×10^9/L、且计算校正血小板计数增加值（CCI）〉7.5×10^9/L、血小板回收率（PPR）〉30%视为有效输注；PLTC上升至（50-99）×10^9/L，且CCI〉7.5×10^9/L、PPR〉30%视为部分有效输注；PLTC〈50×10^9/L，或CCI≤7.5×10^9/L，或PPR ≤30%视为无效输注。结果共纳入46例患儿进行研究，输注完成后1 h, PLTC结果显示：有效输注44例，部分有效输注2例，无效输注0例。患者在血小板输注期间无过敏、心衰等并发症出现。结论术前12-24 h内单次大剂量输注血小板，可有效提高激素不敏感型卡梅现象患儿术前血小板水平，该方法安全有效，为手术和麻醉提供了凝血保障，为手术切除病灶创造了更好的条件。Objective To assess the safety and effectiveness of sufficient, short-term platelet （PLT） transfusion for the surgery preparation of the infantile patients with Kasabach-Merritt phenomenon, who were insensitive to glueocorticoids. Methods The infantile cases were retrospectively analyzed during May 2011 to December 2016, who were clinically diagnosed as KMP and insensitive to glucocortieoids, received PLT transfusion and surgical resection. PLT transfusion in patients whose PLTC was less than 30 x 10^9/L, was 0.3 therapeutic dose （TD）/kg, and 0.2 TD/kg in PLTC ≥ 30 × 10^9/L group. The maximum was 1 TD. Criteria of the PLT transrusion： 1 hour after the transfusion, the PLT count （PLTC） were tested and the corrected count increment of platelet （CCI） and practical platelet recovery （PPR） was calculated. PLTC ≥ 100 × 10^9/L, CCI 〉 7.5 ×10^9/L and PPR 〉 30% were defined as effective;while PLTC = （50 -99） × 10^9/L,CCI 〉7.5 × 10^9/L and PPR 〉30% as partial effective; PLTC 〈50 × 10^9/L,or CCI≤7.5 ×10^9/L,or PPR ≤30% were defined as ineffective. By reviewing the method and response of their PLT infusions, to figure out the most effective way in rising PLT, as a part of pre-operation treatment. Results There were 46 cases in the research. Based on the PLTC, CCI and PPR 1 hour after PLT transfusion, there were 44 effective transfusion,2 patients with partial effectiveness, and no ineffective case. There was no allergic or heart failure happened in any cases. No critical potential complications of PLT transfusion occurred, including fluid and iron overload, alloimmunization to human leukocyte antigen and/ or PLT antigen. Conclusions Pre-operative sufficient and short-term PLT infusions are more effective than low dose and long-term ones. They can create a more optimistic opportunity for surgical resections.

关 键 词：卡梅现象 婴幼儿 血小板输注 

分 类 号：R457.1[医药卫生—治疗学]