肝硬化门静脉高压综合征断流术前输注血小板对预后的影响

Effect of Preoperative Blood Platelet Infusion on Prognosis of Cirrhosis Portal Hypertension Syndrome Patients before Devascularization

目的探讨肝硬化门静脉高压综合征(portal hypertension,PTH)术前输注血小板对预后的影响,为评估断流手术安全性提供理论依据。方法选取我院2011年7月—2012年6月收治的78例肝硬化PTH,按照随机数字表法分为观察组及对照组,每组各39例。两组均接受断流手术治疗,同时观察组术前输注机采血小板10 U。比较两组围手术期外周血血小板计数的变化、术后7 d内腹腔引流量和血制品使用情况及死亡情况。结果两组术后血小板计数均升高,与术前比较差异有统计学意义(P<0.05);与对照组相比,观察组术后1 h及24 h血小板计数均明显升高,且术后7 d腹腔引流量、红细胞悬液、人血白蛋白及治疗用血小板使用量均显著降低,差异有统计学意义(P<0.05)。观察组血小板输注1 h及24 h后血小板回收率(PPR)分别为(102.37±62.65)%、(106.39±54.52)%,血小板计数校正增高指数(CCI)分别为(29.05±16.28)%、(31.29±12.33)%。术后7 d观察组死亡2例(5.13%),对照组死亡3例(7.69%),差异无统计学意义(P>0.05)。结论术前输注血小板能有效减少肝硬化PTH断流术后急性期再出血的发生率,降低血液制品使用量。

Objective To investigate the effect of preoperative blood platelet infusion on prognosis of cirrhosis portal hypertension （ PTH） syndrome patients before surgery in order to provide a reference for evaluating of devascularization opera-tion. Methods A total of 78 cirrhosis PTH syndrome patients admitted during July 2011 and June 2012. were divided into observation group （n=39） control group （n=39） according to random digits table method. All patients received devascular-ization, while the observation group was added with preoperative transfusion of apheresis platelet 10 U. Changes of platelet count during peroperative period, daily peritoneal volume, usage of blood products and mortality at postoperative 7^th d were compared between two groups. Results Postoperative values of platelet count were significantly increased compared with those before surgery in two groups （P〈0. 05）. Compared with those in control group, in observation group, values of platelet count on postoperative 1^st h and 24^th h were significant increased; values of postoperative 7 d daily peritoneal volume, red blood cell suspension, human albumin and platelet dosage were significantly lower （P〈0. 05）. In observation group, platelet recovery rate （PPR） were （102. 37 ± 62. 65）% and （106. 39 ± 54. 52）%, and corrected count increment （CCI） of postop-erative platelet were up to （29. 05 ± 16. 28）% and （31. 29 ± 12. 33）% respectively 1 h and 24 h after platelet transfusion than those in control group （P 〈0. 05）. There were 2 death cases （5. 13%） in observation group and 3 death cases （7. 69%） in control group after the surgery, but the difference was not statistically significant （P〉0. 05）. Conclusion Preoperative blood platelet infusion can reduce incidence rate of acute hemorrhagic of patients with cirrhosis PTH after devas-cularization, and reduce dosage of blood products.