不同时间窗抗凝治疗对脾切除后继发性血小板升高的临床研究

Effect of different time-window of anticoagulant therapy on secondary thrombocytosis after splenectomy

目的评价不同时间窗抗凝治疗脾切除后继发性血小板升高的疗效及安全性。方法入选脾切除术200例患者,随机分为对照组100例和试验组100例。对照组当血小值〉500×10^9/L时,给予低分子右旋糖酐500mL,低分子肝素钙5000 IU,阿司匹林50 mg,双嘧达莫片75 mg;试验组术后24 h给予低分子右旋糖酐500 mL,低分子肝素钙5000 IU,阿司匹林50mg,双嘧达莫片25 mg。血小板下降至400×10^9/L时停止用药。比较2组患者术后1-29 d血小板计数值变化趋势及差异。结果 2组患者血小板值均于术后15 d达到最高峰值,试验组患者血小板值上升幅度缓慢,术后血小板值未超过500×10^9/L;对照组血小板值上升幅度大,术后15 d血小板值已高达（945.5±154.4）×10^9/L。试验组血小板值在到达最高峰值后,开始缓慢下降,术后21 d其血小板值即恢复正常水平;对照组术后25 d才恢复正常水平。术后3-27 d,试验组血小板值均显著低于对照组（P〈0.05）;术后第29 d,2组患者血小板值比较差异无统计学意义（P〉0.05）。术后3个月,2组患者血小板计数值均在正常范围。结论术后24 h用抗凝治疗可有效防治脾切除术后继发性血小板升高,其效果明显优于常规抗凝治疗。

Objective To evaluate the effect of different time- window of anticoagulant therapy on secondary thrombocytosis after splenectomy.Methods Total of 200 patients with splenectomy were divided into control group（ n = 100） and experiment group（ n = 100）. When thrombocyte was over 500 × 10^9/ L,the control group was given low molecular dextran 500 mL,low molecular heparin calcium 5000 IU,aspirin 50 mg and dipyridamole 25 mg. At postoperation 24 h,the experiment group was given low molecular dextran 500 mL,low molecular heparin calcium5000 IU,aspirin 50 mg and dipyridamole tablets 25 mg. When platelet dropped to 400 × 10^9/ L,drug stopped to be given. The change and difference of blood platelet level were compared between the two groups.Results The blood platelet level in two groups reached peak value at 15 days after splenectomy. In experiment group,the blood platelet level increased slowly and steadily,not exceeding 500 × 10^9/ L. In control group,the blood platelet level increased rapidly and sharply,the peak value reached（ 945. 5 ± 154. 4） × 10^9/ L. The blood platelet level ofexperiment group decreased steadily from the peak value,and at 21 d after splenectomy returned to normal levels. The blood platelet level of control group returned to normal levels at 25 d after splenectomy. At postoperation 3- 27 d,the blood platelet level of experiment group were significantly lower than that in control group,the difference showed statistically significant（ P〈0. 05）. At postoperation 29 d,the blood platelet level of two groups was no statistically significant difference（ P〉0. 05）. At 3 months of splenectomy,the blood platelet level of two groups were within the normal range. Conclusion The early anticoagulant therapy（ postoperation 24 h） can effectively prevent secondary thrombocytosis after splenectomy,superior to conventional anticoagulant therapy.