CAJ | 학술논문

目的：评价不同时间窗抗凝治疗脾切除后继发性血小板升高的疗效及安全性。方法入选脾切除术200例患者，随机分为对照组100例和试验组100例。对照组当血小值＞500×109／L时，给予低分子右旋糖酐500 mL，低分子肝素钙5000 IU，阿司匹林50 mg，双嘧达莫片75 mg；试验组术后24 h给予低分子右旋糖酐500 mL，低分子肝素钙5000 IU，阿司匹林50 mg，双嘧达莫片25 mg。血小板下降至400×109／L时停止用药。比较2组患者术后1～29 d血小板计数值变化趋势及差异。结果2组患者血小板值均于术后15d达到最高峰值，试验组患者血小板值上升幅度缓慢，术后血小板值未超过500×109／L；对照组血小板值上升幅度大，术后15 d血小板值已高达（945．5±154．4）×109／L。试验组血小板值在到达最高峰值后，开始缓慢下降，术后21 d其血小板值即恢复正常水平；对照组术后25 d才恢复正常水平。术后3～27 d，试验组血小板值均显著低于对照组（P＜0．05）；术后第29 d，2组患者血小板值比较差异无统计学意义（ P＞0．05）。术后3个月，2组患者血小板计数值均在正常范围。结论术后24 h用抗凝治疗可有效防治脾切除术后继发性血小板升高，其效果明显优于常规抗凝治疗。
목적：평개불동시간창항응치료비절제후계발성혈소판승고적료효급안전성。방법입선비절제술200례환자，수궤분위대조조100례화시험조100례。대조조당혈소치＞500×109／L시，급여저분자우선당항500 mL，저분자간소개5000 IU，아사필림50 mg，쌍밀체막편75 mg；시험조술후24 h급여저분자우선당항500 mL，저분자간소개5000 IU，아사필림50 mg，쌍밀체막편25 mg。혈소판하강지400×109／L시정지용약。비교2조환자술후1～29 d혈소판계수치변화추세급차이。결과2조환자혈소판치균우술후15d체도최고봉치，시험조환자혈소판치상승폭도완만，술후혈소판치미초과500×109／L；대조조혈소판치상승폭도대，술후15 d혈소판치이고체（945．5±154．4）×109／L。시험조혈소판치재도체최고봉치후，개시완만하강，술후21 d기혈소판치즉회복정상수평；대조조술후25 d재회복정상수평。술후3～27 d，시험조혈소판치균현저저우대조조（P＜0．05）；술후제29 d，2조환자혈소판치비교차이무통계학의의（ P＞0．05）。술후3개월，2조환자혈소판계수치균재정상범위。결론술후24 h용항응치료가유효방치비절제술후계발성혈소판승고，기효과명현우우상규항응치료。
Objective To evaluate the effect of different time-window of anticoagulant therapy on secondary thrombocytosis after splenectomy. Methods Total of 200 patients with splenectomy were divided into control group (n=100) and experiment group (n=100).When throm-bocyte was over 500 ×109/L, the control group was given low molecular dextran 500 mL, low molecular heparin calcium 5000 IU, aspirin 50 mg and dipyridamole 25 mg.At postoperation 24 h, the experiment group was given low molecular dextran 500 mL, low molecular heparin calcium 5000 IU, aspirin 50 mg and dipyridamole tablets 25 mg.When platelet dropped to 400 ×109/L, drug stopped to be given.The change and difference of blood platelet level were compared between the two groups. Results The blood platelet level in two groups reached peak value at 15 days after splenectomy.In experiment group, the blood platelet level increased slowly and steadily, not exceeding 500 ×109/L.In control group, the blood platelet level increased rapidly and sharply, the peak value reached ( 945.5 ±154.4 ) ×109/L.The blood platelet level of experiment group decreased steadily from the peak value, and at 21 d after splenectomy returned to normal levels.The blood platelet level of control group returned to normal levels at 25 d after splenectomy.At postoperation 3-27 d, the blood platelet level of experiment group were significantly lower than that in control group, the difference showed statis-tically significant (P<0.05).At postoperation 29 d, the blood platelet level of two groups was no statistically signifi-cant difference(P>0.05).At 3 months of splenectomy, the blood platelet level of two groups were within the normal range.Conclusion The early anticoagulant therapy ( postoperation 24 h) can effectively prevent secondary thrombocy-tosis after splenectomy, superior to conventional anticoagulant therapy.