血液病患者血小板输注临床疗效及相关因素分析

Clinical efficacy and risk factors of platelet transfusion in patients with hematopathy

目的探讨血液病患者血小板输注的临床疗效及导致无效输注的相关危险因素。方法 2009年1月—2012年4月浙江省丽水市人民医院血液科收治的76例需输注血小板的血液病患者为研究对象。对76例患者进行血小板输注,并分析比较血小板输注前后的临床疗效、血小板计数。同时对比有效输注组与无效输注组患者在血小板输注次数、输注原因、基础疾病等方面有无差别,探讨影响血小板输注效果的临床相关因素。结果入组的76例血液病患者共输注血小板悬液276例次,其中有效血小板输注共163例次,有输注率为59.1%;无效输注113例次,无效输注率为40.9%。输注前后的血小板计数分别为(14.11±6.88)×109/L和(34.69±12.46)×109/L,血小板输注后较输注前计数显著上升,且差别有统计学意义(t=14.03,P<0.05);多次输注患者无效输注率显著高于单次输注患者(P<0.05)且输注次数越多输注效果越差(P<0.05),相关性检验发现患者血小板输注次数与输注效果呈负相关(rspearson=-0.68,P<0.05);不同血液病患者血小板输注效果不同,且各组间差别有统计学意义(χ2=17.43,P<0.05),其中特发性血小板减少性紫癜患者输注有效率最高,为87.2%,再生障碍性贫血患者输注有效率最低,为48.8%。结论临床输注血小板悬液应根据疾病类型选择性输注,减少重复输注,提高血小板输注效率。

Objective To study the clinical efficacy of platelet transfusion and related clinical characteristics in patients with hematopathy. Methods Total 76 cases of hematopathy in our hospital from Apr. 2009 Apr. 2012 were enrolled in this study,and platelet transfusion was performed in all patients. The clinical efficacy and platelet count were compared before and after the treatment. The times,causes and underlying disease were compared between effective group and invalid group to discuss the clinical factors related to the efficacy of platelet transfusion. Results A total of 276 times platelet transfusion were performed in all 76 patients. 163 times of effective platelet transfusion accounted for 59. 1% and 113 times invalid accounted for 40. 9%. The platelet count was significant increased after the platelet transfusion[from（14.11 ±6.88） ×10^9/L to（34. 69 ± 12. 46） × 10^9/L,t = 14. 03,P〈0. 05];The rate of non-effective transfusion in patients with multiple transfusion group was much higher than that of single platelet transfusion group（ P〈0. 05）,And the transfusion efficacy was negative correlated with the times of transfusion（rpearson=- 0. 68,P〈0. 05）. The platelet transfusion efficacy was different among different blood diseases（χ^2= 17. 43,P〈0. 05）with the highest efficacy rate in patients with idiopathic thrombocytopenic purpura（ 87. 2%） and lowest efficacy rate in patients with aplastic anemia.Conclusion Platelet transfusion should be performed on the base of clinical disease type,and avoid of repeated transfusion in order to improve its transfusion efficiency.