CAJ | 학술논문

目的探讨脾切除断流术前输注血小板对预防术中、术后出血的有效性和必要性.方法选取行脾切除贲门周围血管离断术的230例肝硬化门脉高压症患者,根据术前血小板计数值分为A、B、C三层,即:术前血小板计数值分别为＜30×109/L、30～50×109/L、＞50×109/L;每层再随机分为术前输血小板组(T组)和术前未输血小板组(NT组).分别比较T组和NT组术中出血量、术后2d引流总量、术后出血发生率;并对T组与NT组的一般基本情况进行比较.结果 A层中T组与NT组比较,术中出血量减少(P＜0.05),术后2d引流量减少(P＜0.05),术后发生出血率降低(P＜0.05).B层和C层中T组与NT组比较,术中出血量、术后2d引流量及术后出血发生率差异均无统计学意义(P＞0.05).结论对于血小板计数小于30×109/L的肝硬化门脉高压症患者,术前输注血小板止血效果明显,脾切除断流术前应常规输注血小板.对于血小板计数值为30～50×109/L之间和50×109/L以上的肝硬化门脉高压症患者,术前输注血小板并无明显效果,不主张常规术前输注血小板.
목적 탐토비절제단류술전수주혈소판대예방술중、술후출혈적유효성화필요성.방법 선취행비절제분문주위혈관리단술적230례간경화문맥고압증환자,근거술전혈소판계수치분위A、B、C삼층,즉:술전혈소판계수치분별위＜30×109/L、30～50×109/L、＞50×109/L;매층재수궤분위술전수혈소판조(T조)화술전미수혈소판조(NT조).분별비교T조화NT조술중출혈량、술후2d인류총량、술후출혈발생솔;병대T조여NT조적일반기본정황진행비교.결과 A층중T조여NT조비교,술중출혈량감소(P＜0.05),술후2d인류량감소(P＜0.05),술후발생출혈솔강저(P＜0.05).B층화C층중T조여NT조비교,술중출혈량、술후2d인류량급술후출혈발생솔차이균무통계학의의(P＞0.05).결론 대우혈소판계수소우30×109/L적간경화문맥고압증환자,술전수주혈소판지혈효과명현,비절제단류술전응상규수주혈소판.대우혈소판계수치위30～50×109/L지간화50×109/L이상적간경화문맥고압증환자,술전수주혈소판병무명현효과,불주장상규술전수주혈소판.
Objectives To study the effect of preoperative platelet transfusion for splenectomy and devascularization in the prevention of intraoperative and postoperative bleeding.Methods The 230 patients with cirrhosis and portal hypertension who received splenectomy and periesophagogastric davascularization were divided into strata A,B and C according to the platelet counts.Stratum A patients had a platelet count of less than 30× 10/L,B between 30× 10/L and 50× 109/L,and C more than 50 × 109/L.The patients in each stratum were then randomly divided into a preoperative transfusion group (T group) and a non-transfusion group (NT group).The amounts of intraoperative bleeding,postoperative drainage in 48 hours after operation,rates of postoperative bleeding,and general medical conditions were compared.Results A comparison in stratum A showed lower amounts of intraoperative bleeding and 48 hour postoperative drainage,and a lower rate of bleeding in the T group (P＜0.05).There were no significant differences between the T and the NT groups in strata B and C (P＞0.05).Conclusions For patients with a platelet count lower than 30 × 109/L,preoperative platelet transfusion significantly reduced bleeding suggesting that preoperative platelet transfusion for splenectomy and periesophagogastric devascularization should be a routine.For those patients whose platelet count was above 30 × 109/L,platelet transfusion is not recommended.