肝移植患者围术期血小板及其检测参数分析

Variations of interrelated parameters of blood platelets during the peri-operative period of liver transplantation

目的探讨肝移植患者围术期血小板及其参数的变化规律和肝移植术后血小板减少的原因及监测血小板参数的临床意义。方法分别检测我院实施肝移植患者200例术前1 d及术后1、2、4、6、8、10、12、15 d的PLT、MPV、PDW、P-LCR四项参数。以术后15 d内PLT尚未恢复正常的44例(未恢复组)与恢复正常的156例(恢复组)进行对比分析。结果未恢复组术前PLT明显低于恢复组(P<0.01),PDW、MPV、P-LCR两组无明显差异(P>0.05)。未恢复组和术前比较,术后第4天PLT为最低,而后略有回升,但直至第15天仍未恢复正常。恢复组和术前比较,术后第6天PLT最低,而后逐渐回升,直至15天基本恢复正常。从术前至术后15天,恢复组PLT均高于未恢复组(P<0.05)。PDW两组术后亦无明显差异(P>0.05)。术后未恢复组随着PLT的降低,MPV、P-LCR进一步降低,恢复组随着PLT的降低而MPV、P-LCR却升高,两组差异显著(P<0.05)。结论 P-LCR、MPV对判断肝移植术后血小板减少原因是重要的指标之一。血小板及其参数的监测对肝移植术后病情变化的判断有一定参考价值。

Objective To study the variations of interrelated parameters of blood platelets during the perioperative period of liver transplantation, and the causes of platelet reduction after operation. Methods PLT, MPV, PDW, P - LCR from 200 liver transplant patients were determined the day before operation, and on d 1, d 2, d 4, d 6, d 8, d 10 ,and d 12 after operation. Patients were divided into recovery group （ n =44） and non - recovery group （ n = 156） according to the level of PLT during the 15 clays after operation. We compared all the interrelated parameters of blood platelets between the two groups. Results Before operation, the PLT levels in non - recovery group were lower than those in recovery group （ P 〈 0.01 ）. However, there was no significant difference between the two groups in PDW, MVP, and P -LCR （P 〉 0.05 ）. The lowest PLT level was found on the 4th day after operation in non -recovery group but on the 6th day in recovery group. PLT, MPV, and P - LCR decreased in non - recovery group while they increased in recovery group. Conclusions Determination of interrelated parameters of blood platelets is very important for liver transplant patients to reduce the risk of hemorrhage after operation.