血小板减少性孕妇手术麻醉方式选择及血小板输注治疗

目的研究血小板减少性孕妇手术麻醉方式的选择及血小板输注的临床效果。方法将我院202例妊娠期血小板减少孕妇抽签随机分为观察组与对照组,麻醉方式根据患者血小板计数而定,50×10~9/L采取局麻配合静脉麻醉,50×10~9/L采取硬膜外麻醉,两组另同时接受糖皮质激素波尼松治疗,观察组患者另给予血小板输注治疗,对两组血小板水平变化、康复时间及出血量进行比较,并对不同麻醉方式选择进行分析。结果观察组血小板输注后完全反应、部分反应率分别为55.45%、41.58%与对照组43.56%、39.60%比较偏高,但比较无统计学意义(P0.05),对照组无反应16.83%与观察组2.97%比较显著较高(P0.05);分娩后1、2、3 d两组血小板值较分娩前明显升高,与前一时间段比较差异均有统计学意义(P0.05),同时间段比较观察组血小板计数水平显著高于对照组(P0.05),观察组康复时间及出血量分别为(5.39±1.05)d、(256.25±82.69)ml与对照组(9.51±2.14)d、(315.28±102.62)ml比较显著较低(P0.05)。结论妊娠期血小板减少手术应根据患者血小板水平制定不同的麻醉方式,50×10~9/L建议采取局麻配合静脉麻醉,50×10~9/L采取硬膜外麻醉,血小板输注与糖皮质激素可短时间矫正血小板低下,具有较高的临床应用价值。

The Selection of Anesthetic Methods for Women with Gestational Thrombocytopenia and the Effect of Platelet Transfusion

Objective To study the selection of anesthetic methods for women with gestational throm-bocytopenia and observation on the clinical effect of platelet transfusion. Methods 202 women with gestation-al thrombocytopenia in the hospital were randomly divided into the observation group and the control group. The anesthetic method was determined according to the patient 's platelet count. Patients with platelet count less than 50 × 109/ L received local anesthesia combined with intravenous anesthesia while patients with platelet count more than 50 × 109/ L received epidural anesthesia. Then all the patients in the two groups received glucocorticoid prednisone treatment and the observation group were additionally given platelet transfusion therapy. The changes of platelet level,the time of recovery and the amount of bleeding between the two groups were compared and the selection of different anesthesia was analyzed. Results In the observation group,the rates of complete response and partial response after platelet transfusion respectively were 55. 45%and 41. 58% which were higher than 43. 56% and 39. 60% in the control group,but there is no significant difference(P>0. 05). The rate of adiaphoria of the control group was 16. 83% which were significantly higher than 2. 97% of the observation group(P<0. 05);1,2 and 3 d after delivery,the platelet values of the two group were significantly higher than those before delivery. Compared with the previous period of time, there were statistically significant differences ( P <0. 05 ) . In the same time, the platelet count of the observation group was significantly higher than that of the control group ( P<0. 05 ) . The time of recovery and amount of hemorrhage of the observation group respectively were(5. 39 ±1. 05)d and(256. 25 ±82. 69)ml which were significantly lower than(9. 51 ±2. 14)d and(315. 28 ±102. 62)ml of the control group(P<0. 05). Conclu-sion In gestational thrombocytopenia surgery,different anesthetic methods should be selected according to the platelet level in patients. Patients with platelet level less than 50 × 109/ L are suggested to take local anesthe-sia combined with intravenous anesthesia while more than 50 × 109/l should take epidural anesthesia. Platelet transfusions and glucocorticoid can correct thrombocytopenia in short time,which is of high clinical application value.