血小板输注治疗对抗血小板药物脑出血患者围手术期出血的预防

Platelet transfusion prevents the perioperative bleeding in patients with antiplatelet therapy-associated cerebral hemorrhage

目的探讨在血栓弹力图(thromboelastography,TEG)指导下血小板输注治疗对口服抗血小板药物脑出血患者围手术期出血情况及输血量的影响。方法回顾性分析30例行急诊手术治疗的抗血小板药物基底节区脑出血患者,其中12例行血小板输注,比较在TEG指导下有无输注血小板治疗对术中、术后出血量及输血量的影响。结果术前两组病例凝血常规检查在正常范围,但血栓弹力图提示血小板功能过度抑制(血小板抑制率>90%),比较两组病例术中出血量(t=-3.998,P=0.008)、输血总量(Z=-3.245,P=0.001)、术后血肿残余量(t=-2.909,P=0.043)、引流量(t=-8.790,P=0.041),提示差异有统计学意义。输血小板组1例,未输血小板组4例行二次手术,两者比较无统计学意义(χ~2=1,P=0.317)。结论 TEG检测指标能够更全面准确地评估患者术前凝血功能,研究提示术前血小板输注,一定程度上改善抗血小板治疗后脑出血患者术中、术后出血情况,减少输血量。

Objective To explore the application value of thromboelastography（TEG） in perioperative evaluation of patients with antiplatelet therapy-associated cerebral hemorrhage. We aimed to investigate whether platelet transfu-sion, compared with standard care, reduced bleeding in patients with antiplatelet therapy-associated cerebral hemor-rhage. Methods A retrospective analysis of clinical data was conducted in 30 patients（12 patients receiving platelet transfusion） with antiplatelet therapy-associated basal ganglia hemorrhage who underwent emergency surgery. TEG was used to evaluate the intraoperative bleeding, postoperative bleeding and transfusion treatment. Results The routine coagulation test was in the normal range in the two groups. However, TEG showed that the platelet function was exces-sively inhibited in patients with antiplatelet therapy before spontaneous cerebral hemorrhage（Platelet inhibition rate 〉90%）. There were significant differences in the intraoperative blood loss（ t=-3.998, P=0.008）, total transfusion volume（Z=-3.245, P=0.001）, postoperative hematoma volume（t=-2.909, P=0.043） and lead volume（t=-8.790, P=0.041） between two groups（P 〈0.05）. One case from platelet transfusion group, and 4 cases from no-platelet transfusion group re-ceived a second surgical operation. However, the difference was not statistical significant（ P=0.317）. Conclusion TEG can effectively assess the preoperative coagulation status in the patients with spontaneous cerebral haemorrhage after antiplatelet therapy. Platelet transfusion can reduce intraoperative and postoperative bleeding, decrease blood transfu-sion in the patients with antiplatelet therapy-associated cerebral hemorrhage.