术中使用糖皮质激素对心胸外科患者术后外周血三系的影响研究  

Effect of glucocorticoid administration on peripheral blood counts in patient undergoing cardiothoracic surgery

作　　者：胡洁茹[1] 田伟强[1] 郑春辉[2] 徐艳艳[1] HU Jieru;TIAN Weiqiang;ZHENG Chunhui;XU Yanyan(Department of Pharmacy,Lishui Municipal Central Hospital,Lishui 323000,China)

机构地区：[1]丽水市中心医院药学部,323000 [2]丽水市中心医院心胸外科,323000

出　　处：《浙江医学》2021年第16期1724-1728,共5页Zhejiang Medical Journal

基　　金：浙江省自然科学基金资助项目(LY18H300007);丽水市高层次人才培养资助项目(2018RC06);丽水市科技计划项目(2015sjzc19)。

摘　　要：目的探讨术中使用糖皮质激素(GC)对心胸外科手术患者术后外周血三系指标(WBC、RBC、PLT)的影响。方法回顾性分析2016年1月至2018年12月丽水市中心医院心胸外科行手术治疗的患者259例,根据有无使用GC分为激素组183例和无激素组76例,根据术中GC使用剂量将激素组分为低剂量组(剂量≤5 mg)107例、中剂量组(5 mg<剂量<22.5 mg)50例、高剂量组(22.5 mg≤剂量≤93.75 mg)26例,比较各组患者性别、年龄、合并基础疾病、术前、术后外周血三系指标。结果激素组和无激素组患者术前WBC、RBC、PLT水平比较差异均无统计学意义(均P>0.05);术后各时间点WBC、RBC、PLT水平均较术前有明显变化,其中WBC、PLT水平均较术前明显升高,而RBC水平则较术前明显降低(均P<0.05);激素组患者术后各时间点WBC水平均明显高于无激素组,RBC、PLT水平均明显低于无激素组(均P<0.05)。3个剂量组患者术前WBC、RBC、PLT水平比较差异均无统计学意义(均P>0.05);各组患者术后各时间点WBC、RBC、PLT水平(除术后3~6 d时的RBC水平外)与同组术前相比差异均有统计学意义(均P<0.05),其中术后WBC水平均较本组术前明显升高,RBC水平较本组术前明显降低,而PLT术后水平较术前先下降,3~6 d开始回升,7~10 d以后PLT水平高于术前;与低剂量组相比,中、高剂量组术后各时间点WBC、RBC、PLT水平(除术后0~2 d时的RBC水平外)差异均有统计学意义(均P<0.05),其中与低剂量组相比,中、高剂量组各时间点WBC水平升高,RBC水平降低,PLT水平先降低后升高;高剂量组术后各时间点RBC、PLT水平与中剂量组比较差异均有统计学意义(均P<0.05)。结论GC会影响心胸外科手术患者术后外周血三系指标水平,中、高剂量GC可升高术后WBC,并降低RBC、PLT。Objective To investigate the effect of glucocorticoid administration on peripheral blood counts in patient undergoing cardiothoracic surgery.Methods Clinical data of 259 patients undergoing cardiothoracic surgery in the Lishui Municipal Central Hospital from January 2016 to December 2018 were retrospectively analyzed.There were 183 patients receiving glucocorticoids during the surgery(hormone group)and 76 patients without administration of glucocorticoids(hormone-free group).In hormone group,the dose of glucocorticoids was≤5 mg in 107 cases(low dose group),5 mg<dose<22.5 mg in 50 cases(medium dose group)and 22.5 mg≤dose≤93.75 mg in 25 cases(high dose group).The peripheral blood leukoc-yte(WBC),erythrocyte(RBC),and thrombocyte(PLT)counts were measured and compared among groups.Results There were no significant differences in WBC,RBC and PLT counts before operation between hormone group and hormone-free group(P>0.05).After operation the WBC and PLT counts were significantly higher than those before operation,while the level of RBC was significantly lower than that before operation(P<0.05)in both groups.The WBC counts in hormone group were significantly higher than those in hormone-free group,while the RBC and PLT counts were significantly lower than those in hormone-free group(P<0.05).There was no significant difference in preoperative WBC,RBC and PLT levels among the three dose groups(P>0.05).There were no significant changes in WBC,RBC and PLT counts in each dose groups at all time point after operation(P>0.05),except the RBC counts at 3-6 days after operation(P<0.05).The level of WBC after operation was significantly higher than that before operation,the level of RBC was significantly lower than that before operation.The level of PLT after operation was lower than that before operation until 6 days after operation,and at 7-10 days after operation it was higher than that before operation.Compared with the low-dose group,the WBC level at each time point in the medium and high-dose groups increased,the RBC le

关 键 词：糖皮质激素 白细胞计数 红细胞计数 血小板计数 

分 类 号：R655[医药卫生—外科学]