血液病患者血小板输注效果评价及其影响因素探讨

Curative effects of platelet transfusion and its influence factors in patients with hematologic diseases

目的探讨血液病患者血小板输注的有效率及其影响因素。方法对79例血液病患者给予输注机采血小板共322例次,输注后18～24小时进行外周血血小板计数,根据血小板回收率(PPR)和血小板计数增高指数(CCI)评价血小板输注效果,并探讨其影响因素。结果急性白血病(AL)、再生障碍性贫血(AA)、特发性血小板减少性紫癜(ITP)和骨髓增生异常综合征(MDS)患者血小板输注有效率分别为74.39%、71.86%、50.54%和63.64%(P<0.01)。AL、MDS组中发热患者血小板输注有效率低于未发热患者(分别为P<0.01和P<0.05)。AL、MDS组中脾脏肿大患者血小板输注有效率低于脾脏不肿大患者(P<0.01)。AL患者是否发生弥漫性血管内凝血(DIC)血小板输注有效率有显著差别(P<0.05)。无并发症组患者血小板输注有效率随输注次数的增加而下降(P<0.01),而有并发症组患者血小板输注有效率与输注次数关系不大(P>0.05)。结论输注血小板是预防和治疗因血小板减少或血小板功能障碍而引起的出血的最有效的措施。引起血小板输注无效的病因复杂,发热、脾肿大、DIC、输注次数等是影响血小板输注效果的重要因素。

Objective To explore the efficacy and influence factors of patelet transfusion in patients with hematologic diseases, Methods The engine picked platelet were transfused 322 times to 79 patients. Peripheral blood platelet count was made at 18 to 24 hours after platelet transfusion. The effectiveness was assayed by percentage platelet recovery （PPR） and corrected count increment （CCI）. And then the influence factors were analyzed. Results The effective rate of acuteleukemia（AL） ,aplastic anemia（AA）, idiopathic throbocytopenic purpura （ITP） and myelodysplastic syndrome （MDS） were 74. 39 % ,71.86 % ,50.54 % and 63.64 % respectively （P 〈 0.01）. For patients with AL or MDS, the effective rate of fever group was lower than non-fever group （P 〈 0.01 and P 〈 0.05 respectively）. The same was to the splenomegaly group and non- splenomegaly group （P 〈 0.01）. In AL patients, there was a significant difference in the disseminated intravascular coagulation（DIC） group and the group without DIC （P 〈 0.05）. In non-complication group, the effective rate decreased with the frequency of platelet transfusion increasing. However, there was no relationship between the effective rate and the frequency of platelet transfusion in complication group （P 〉 0.05）. Conclusions Platelet transfusion is a very effective procedure to prevent and cure bleeding in thrombocytopenia. Many factors can induce refractory of platelet transfusion. Fever, splenomegaly, DIC and frequency of transfusion are important influence factors.