前列地尔预防断流术后门静脉血栓形成的临床观察

Effects of ulprostadil in prevention of portal vein thrombogenesis after splenectomy and devascularization ： a clinical observation of 76 patients with portal hypertension

目的探讨前列地尔预防断流术后门静脉系血栓形成的疗效。方法选择2004年7月至2005年8月以肝硬化，门静脉高压症接受断流术治疗的76例患者，随机分为两组。治疗组40例，术后第3天始静脉滴注丹参注射液和前列地尔2周。对照组36例，术后第3天静脉滴注丹参，口服肠溶阿司匹林。定期观察PLT、PT、肝功能、门静脉血栓形成及腹水情况。结果术后治疗组与对照组比较，门静脉系血栓形成发生率差异有统计学意义（P〈0．05）；肝功能恢复差异有统计学意义（P〈0．05）。但血小板恢复差异无统计学意义（P〉0．05）；凝血时间未见明显延长，均无出血倾向。结论前列地尔在断流术后早期应用能有效、安全预防门静脉系血栓形成、改善肝功能和降低腹水发生率。

Objective To investigate the effects of alprostadil （ Lipo PGE1 ） in prevention of portal vein thrombogenesis （PVT） after splenectomy for portal hypertension. Methods Seventy-six patients with portal hypertension undergoing splenectomy and pericardia[ devascularization were randomly divided into 2 groups ： treatment group （ n = 40 ）, receiving intravenous drip of injection of radix Salviae miliorrhazae （RSM） 40 ml and alprostadil 20μg, both once a day since the third day after operation for 2 weeks and then oral administration of dropping pill of SM, and control group （ n = 36 ）, receiving intravenous drip of injection of RSM and taking enteric coated aspirin 3 times a day for 2 weeks and then taking dropping pill of SM. Platelets （ PLT）, prothrombin time （ PT）, and liver function were detected periodically. Color Doppler ultrasonogTaphy was conducted every week to observe the blood flow velocity and diameter of the portal and splenic veins, and if PVT event and ascites occurred. All patients were followed up for 8 - 20 months. Results No prolongation of coagulation time and bleeding tendency was found in both groups. The PLT number increased remarkably in the 7th to 14th days after operation without significant difference between the 2 groups （ P 〉 0.05 ）. The PVT rate of the treatment group was 5.0% , significantly lower than that of the control group （ 25.0%, x^2 = 6. 12, P 〈 0. 05 ）. The ascites rate of the treatment group was 10. 0%, significantly lower than that of the control group （ 33.3%, x^2 = 7.44 ,P 〈 0.01 ）. The levels of ALT and total bilirubin 7 and 16 days after operation of the treatment group were all significantly lower than those of the control group （all P 〈 0.05 ）. Conclusion Use of alprostadi] early after devascularization is an effective and safe measure to prevent PVT, improve liver function, and decrease ascites rate.