小儿原发性血小板减少性紫癜脾切除的围手术期处理

The Perioperative Management of Splenectomy for Chronic Idiopathic Thrombocytopenic Purpura in 21 Children

回顾性分析 1990年至 2 0 0 1年内科治疗无效 ,后经脾切除的 2 1例小儿原发性血小板减少性紫癜的病例 ,探讨围手术期处理及治疗效果。 2 1例术前均有出血症状 ,1例术前颅内出血死亡。 2 0例术后 1周内血小板恢复正常 ;1例术后诉头痛 ,CT疑有轻微颅内出血 ,经治疗治愈 ;5例发生切口脂肪液化。提示 :术前积极护肝治疗 ,改善患儿凝血功能是保证手术安全的基础 ,术前患儿血小板低于 5 0× 10 9/L 是输注浓缩血小板的指征 ;术中先结扎脾动脉是减少术中出血的重要措施 ;围手术期应预防性使用广谱抗生素 ,术后血小板超过 4 0 0× 10 9/L 者应行抗血小板凝集治疗。

The medical records of 21 idiopathic thrombocytopenic purpura (ITP) children undergoing splenectomies from 1990 to 2000 were reviewed retrospectively. The perioperative management and the curative outcome were discussed. Results showed that in the 21 cases of ITP, all had bleeding syndrome preoperatively. One died of intracranial hemorrhage before operation. The platelets restored to normal level within one week postoperation in 20 cases. One child complained of a headache postoperation and was suspected of mild intracranial hemorrhage by CT. The fat liquefaction of wound occurred in 5 cases. It was concluded that improvement of coagulation function was essential for operation; Preoperation platelet number less than 50×10 9/L was the indication of concentrated platelet transfusion; Ligation of splenic artery first during operation can decrease the blood loss; Prophylactic antibiotics should be given pre and post operation; Antiplatelet coagulation therapy should be given to the patients with platelets over 400×10 9 /L after operation.