神经急重症合并血小板减少症患者的围手术期处理及手术疗效

Perioperative management and surgical treatment of neurosurgical critical patients with thrombocytopenia

目的 分析神经急重症合并血小板减少症的围手术期处理及手术疗效.方法 回顾性分析2010年2月至2015年5月北京协和医院11例神经急重症合并血小板减少症手术患者的临床资料.11例患者术前均有不同程度的血小板减少,均在术前接受输注血小板治疗.通过观察术后6个月GOS评分评价治疗效果.结果 11例中6例微创手术术前血小板计数纠正至80×10^9/L,5例开颅及脑室腹腔分流术术前血小板计数纠正至100×10^9/L并在术中输注血小板,根据术后血小板计数,8例术后输注血小板,11例均围手术期顺利.术后2例院内死亡,1例出院后死亡,其他8例术后6个月GOS评分平均4.5（4～5）分.结论 合并血小板减少症的神经急重症患者,可在相关科室的协作下,很好的完成神经外科手术,改善预后.

Objective To study the perioperative management and surgical treatment of patients with neurosurgical critical diseases and thrombocytopenia.Methods Eleven patients with the diagnosis of neurosurgical critical diseases and thrombocytopenia who received surgical treatment in Department of Neurosurgery,Peking Union Medical College Hospital from 2010 to 2015 were reviewed retrospectively.All eleven patients received platelet transfusions preoperatively.The safety and efficacy of surgical treatment were analyzed by GOS score at 6 months after operations.Results Platelet counts of six patients who received minimally invasive surgery reached 80 × 10^9/L by platelet transfusions preoperatively.Platelet counts of five patients who received Craniotomy and ventriculoperitoneal shunt reached 100×10^9/L by platelet transfusions preoperatively.Eight patients received platelet transfusions postoperatively according to a low platelet count 24 hours after operations.Two patients died after surgery and one died after discharge.All other eight survival patients got well recovery with an average GOS score of 4.5 at six months after operations.Conclusions Patients with neurosurgical critical diseases and thrombocytopenia could receive surgical treatment in collaboration with relative departments.