肝移植治疗脾功能亢进相关终末期肝病

背景：肝移植已成为治疗脾亢相关终末期肝病最理想的方法,行肝移植过程中保留脾脏,是否会出现移植后脾功能亢进相关问题,目前尚无统一的认识。目的：观察肝移植治疗脾功能亢进相关终末期肝病移植后脾功能的恢复过程。方法：纳入肝移植治疗终末期肝病患者63例,按有无脾功能亢进分为脾亢组和非脾亢组。比较两组移植后血小板计数、彩超测定脾脏上下径、厚度、门静脉直径及随访15个月的结果。结果与结论：纳入患者63例,死亡8例,55例进入结果分析。其中,肝移植并行切脾者4例,仅1例存活。脾亢组移植手术结束时血小板较移植前明显降低,移植后3d降至最低,而后逐渐上升,移植后7d明显增加（P〈0.05）,稳定至15个月;非脾亢组血小板移植后5d降至最低,17d达到移植前水平,两组比较差异均有显著性意义（P〈0.05）。移植后7d脾脏上下径及厚度开始明显减小（P〈0.05）,3个月脾静脉直径明显减小（P〈0.05）,至15个月稳定,患者均无门静脉高压曲张静脉破裂出血史。说明肝移植过程中若无绝对切除脾脏的适应症,应尽量保留脾脏。     

肝移植治疗脾功能亢进相关终末期肝病

背景:肝移植已成为治疗脾亢相关终末期肝病最理想的方法,行肝移植过程中保留脾脏,是否会出现移植后脾功能亢进相关问题,目前尚无统一的认识。目的:观察肝移植治疗脾功能亢进相关终末期肝病移植后脾功能的恢复过程。方法:纳入肝移植治疗终末期肝病患者63例,按有无脾功能亢进分为脾亢组和非脾亢组。比较两组移植后血小板计数、彩超测定脾脏上下径、厚度、门静脉直径及随访15个月的结果。结果与结论:纳入患者63例,死亡8例,55例进入结果分析。其中,肝移植并行切脾者4例,仅1例存活。脾亢组移植手术结束时血小板较移植前明显降低,移植后3d降至最低,而后逐渐上升,移植后7d明显增加(P<0.05),稳定至15个月;非脾亢组血小板移植后5d降至最低,17d达到移植前水平,两组比较差异均有显著性意义(P<0.05)。移植后7d脾脏上下径及厚度开始明显减小(P<0.05),3个月脾静脉直径明显减小(P<0.05),至15个月稳定,患者均无门静脉高压曲张静脉破裂出血史。说明肝移植过程中若无绝对切除脾脏的适应症,应尽量保留脾脏。     

门静脉高压症脾切除术后血栓形成的危险因素分析及护理对策

目的探讨门静脉高压症脾切除术后血栓形成的危险因素及护理对策。方法选择2015年2月~2016年8月我院接受手术治疗的门静脉高压症患者283例,并收集患者的相关临床资料(年龄、性别、体质量指数、是否合并糖尿病、Child-Pugh分级、手术时间、脾脏大小、术后是否抗凝、术后血小板计数、D-二聚体水平、门静脉内径、手术方式、凝血酶原时间、术前食管胃底静脉曲张程度),分析门静脉高压症脾切除术后血栓形成的危险因素。结果本次调查的283例门静脉高压症脾切除患者中,79例术后形成血栓,血栓形成率为27.92%。经Logistic多因素回归分析显示,年龄≥60岁、糖尿病、Child-Pugh C级、脾脏≥150mm2、术后未抗凝、术后血小板计数350×109/L、D-二聚体≥280ng/ml、门静脉内径≥15mm、手术方式为脾切+断流术、术前食管胃底静脉曲张程度较重为门静脉高压症脾切除术后血栓形成的独立危险因素。结论多种危险因素均可引发门静脉高压症脾切除患者术后形成门静脉血栓(PVT),应针对各种危险因素予以相应的护理措施,以降低PVT的发生率。     

门静脉高压症脾切除术后血栓形成的危险因素及护理干预

目的探讨门静脉高压症脾切除术后血栓形成的危险因素及相关护理方法。方法选取123例门静脉高压症脾切除术患者为研究对象,按照术后是否出现门静脉血栓(PVT)分为PVT组40例和非PVT组83例,对可能造成患者形成PVT的相关因素进行统计学分析。结果 PVT组的腹水史、脾容积、门静脉宽度、脾静脉宽度、血小板计数、D-二聚体及抗凝药物的使用与非PVT组比较差异有统计学意义(P0.05)。经多因素Logistic分析发现,血小板计数、门静脉宽度、脾静脉宽度、未使用抗凝药物是门静脉高压症脾切除术后PVT形成的独立危险因素(P0.05)。结论门静脉高压症脾切除术后PVT受众多因素的影响,术后应该针对PVT形成的危险因素给予相关护理干预。     

SWI序列脾脏Gamna—Gandy小体数量在评价肝硬化门静脉高压程度中的作用

目的：本研究将磁敏感加权成像技术（Susceptibility-weightedimaging,SWI）应用于门静脉高压患者脾脏扫描,通过计算SWI序列上脾脏Gamna-Gandy小体（Gamna-Gandybody,GGB）的数量评价它在无创评价门静脉高压程度中的作用。方法：对135例肝硬化门静脉高压患者以及37例正常对照人群行SWI以及常规MR序列扫描并采集血液样本测量血小板数量。计算SWI序列代表层面上脾脏GGB数量。测量和比较正常对照组、GGB阴性组和GGB阳性组门静脉宽度,脾脏指数,血小板脾脏长径比值。将GGB数量分别与门静脉宽度、脾脏指数、血小板计数和血小板脾脏长径比值进行相关性分析。结果：SWI序列上门静脉高压患者脾脏GGB阳性例数为51例。GGB数量为40．9±28．4。GGB阳性患者门静脉横径、脾脏指数、血小板数量以及血小板数量和脾脏长径比值明显大于（或小于）正常对照者和GGB阴性患者。GGB阳性患者SWI序列上GGB的数量与门静脉宽度,脾脏指数呈明显正相关（r=0．624,P〈0．001;r=0．502,P〈0．001）,与血小板计数以及血小板脾脏长径比值呈明显负相关（r=-0．373,P=-0．007;r=-0．704,P〈0．001）。结论：SWI序列上脾脏GGB数量可以作为一种无创的影像学方法判断肝硬化患者门静脉高压的程度。     

门静脉高压症手术后并发肝昏迷的护理

我院外科自1981—1986年共收治门静脉高压症患者73例,施行手术治疗58例中,男37例,女21例;80％的病人年龄在30—50岁;择期手术44例,因上消化道大出血而急诊手术14例;其中8例出现肝昏迷,死亡7例。一、术后肝昏迷预防术后病人肝衰的诱因主要有创伤、感染、再出血、饮食不当等,护理上应注意消除或缓冲这些因素对病人的刺激,达到防止肝衰发生的预期护理目的。 1.创伤:58例手术中,脾脏切除,大网膜包肾术5例;脾脏切除,脾肾静脉分流术8例;脾脏切除,门奇静脉断流术35例。1985年以后开始应用于临床的旨在保留脾脏免疫功能的半脾切除,胃冠     

内镜曲张静脉结扎联合脾栓塞术76例报告

目的：探讨内镜曲张静脉结扎（EVL）联合脾栓塞术（PSE）治疗门静脉高压症的疗效。方法：对76例门静脉高压症合并食管曲张静脉出血和脾功能亢进病人实施EVL联合PSE治疗。结果：76例病人食管曲张静脉均完全闭塞,平均随访21月（3－48月）,复发出血率为6．6％,脾栓塞术后脾脏明显缩小,外周血白细胞与血小板均显著升高（P＜0．01）,结论：EVL联合PSE疗法是治疗门静脉高压症食管静脉曲张出血和脾功能亢进的安全有效方法,该联合疗法比单独EVL更快闭塞曲张静脉,复发出血率低;较外科手术简单,侵袭性小。     

门静脉高压症手术后门静脉血栓形成的临床分析

目的探讨门静脉高压症手术后门静脉系统血栓形成的原因和治疗。方法分析1998年～2004年因肝炎后肝硬化门静脉高压症手术治疗后门静脉系统血栓形成的5例患者,对其临床资料进行分析。结果门静脉血栓易发生在术后15～21d,B超检查简便、可靠。结论门静脉高压症术后门静脉血栓形成的原因与脾切后血小板升高,门静脉系统血流动力学改变有关。手术规范轻柔,术后B超检查,血小板监测,早期抗凝溶栓是防治门静脉高压症手术后门静脉系统血栓形成的有效方法。     

门静脉高压症腹腔镜胆囊切除术13例临床分析

目的 分析肝硬变门静脉高压症病人腹腔镜胆囊切除的手术适应证和手术方法。方法 A组为该院1998～2005年13例门静脉高压症的胆囊结石病人行腹腔镜胆囊切除术。B组为随机抽取同期腹腔镜胆囊切除术200例。将两组进行比较。结果 病人手术顺利，无术后再出血及中转开腹。A组手术时间及术后住院日长于对照组。A组病人术后胆囊床积液及发热高于对照组。结论 腹腔镜胆囊切除术对于正确选择的肝硬变门静脉高压症胆囊结石病人是安全的。     

射频消融术治疗门静脉高压性脾功能亢进症的研究进展

脾肿大脾功能亢进是门静脉高压症最常见的并发症之一。对于肝硬化门静脉高压症的外科治疗，国内一般采用脾切除加断流和（或）分流术。近20年来，通过对脾脏生理功能及脾脏与多种疾病关系的逐渐深入研究，彻底推翻了传统认为脾脏是一个无用器官，可以随便加以切除的错误观念，确定了脾脏是一个有着多种重要功能的器官，有着强大的抗感染、抗肿瘤的免疫功能。由于肝硬化引起的门静脉高压症的病人免疫功能本来已经低下，如果脾切除后必定造成免疫功能进一步低下，有报道表明肝硬化时切脾比无肝硬化情况下病人更易发生感染，其脾切除后凶险性感染发生率是外伤性脾破裂切脾的7倍。     

Plasma thrombopoietin level after liver transplantation: relationship to cold ischemia time and coagulation parameters

Objective: To determine the relation between thrombopoietin (Tpo) levels following orthotopic liver transplantation (OLT), cold ischemia time and postoperative peripheral blood platelet count and prothrombin activity.¶Design: Prospective clinical study.¶Setting: Intensive care unit.¶Patients: Fourteen patients with uncomplicated postoperative course after OLT.¶Measurements and results: Plasma Tpo, as quantified by enzyme immunoassay, rose significantly from 194.9 ± 45.7 pg/ml on day 1 after OLT to a peak value of 500.7 ± 94.1 pg/ml on day 5 while platelet count was below normal values. Then the platelet count increased and reached normal values while Tpo decreased to normal. The rise of Tpo levels was associated with normalization of prothrombin time but peak Tpo concentrations were in inverse correlation with cold ischemia times.¶Conclusion: The extent of production of Tpo in the liver graft following OLT is affected by cold ischemia time. This observation may be applicable in the prevention of bleeding complications associated with postoperative thrombocytopenia.     

Does continuous heparinization influence platelet function in the intensive care patient?

Objective: To study the influence of continuous administration of heparin on platelet function in intensive care patients. Design: Prospective, serial investigation. Setting: Clinical investigation on a surgical and neurosurgical intensive care unit in a university hospital. Patients: The study included 45 patients: 15 postoperative with patients sepsis (Acute Physiology and Chronic Health Evaluation II score between 15 and 25), 15 trauma patients (Injury Severity Score 15 to 25), and 15 neurosurgical patients. Interventions: Management of the patients was carried out according to the guidelines for modern intensive care therapy. Sepsis and trauma patients received standard (unfractionated) heparin continuously [aim: an activated partial thromboplastin time (aPTT) approximately 2.0 times normal value; sepsis-heparin and trauma-heparin patients], whereas neurosurgical patients received no heparin (neurosurgical patients). Measurements and results: From arterial blood samples, platelet aggregation was measured by the turbidimetric method. Platelet aggregation was induced by adenosine diphosphate (ADP; 2.0 μmol/l), collagen (10 μg/ml), and epinephrine (25 μmol/l). Measurements were carried out on the day of diagnosis of sepsis or 12 h after hemodynamic stabilization (trauma and neurosurgery patients) (baseline) and during the next 5 days at 12.00 noon. Standard coagulation parameters [platelet count and fibrinogen and antithrombin III (AT III) plasma concentrations] were also monitored. Heparin 4–10 U/kg per h (mean dose: approximately 500 U/h) was necessary to reach an aPTT of about 2.0 times normal. Platelet count was highest in the neurosurgical patients, but it did not decrease after heparin administration to the trauma and sepsis patients. AT III and fibrinogen plasma levels were similar in the three groups of patients. In the sepsis group, platelet aggregation variables decreased significantly (e. g., epinephrine-induced maximum platelet aggregation: − 45 relative % from baseline value). Platelet function recovered during the study and even exceeded baseline values (e. g., ADP-induced maximum platelet aggregation: + 42.5 relative % from baseline value). Continuous heparinization did not blunt this increase of platelet aggregation variables. In the heparinized trauma patients, platelet aggregation variables remained almost stable and were no different to platelet aggregation data in the untreated neurosurgical patients. Conclusions: Continuous administration of heparin with an average dose of approximately 500 U/h did not negatively influence platelet function in the trauma patients. Recovery from reduced platelet function in the sepsis group was not affected by continuous heparinization. Thus, continuous heparinization with this dose appears to be safe with regard to platelet function in the intensive care patient. Received: 30 July 1996 Accepted: 10 February 1997     

Time course of platelet counts in critically ill patients

BACKGROUND: Although thrombocytopenia in the intensive care unit (ICU) is associated with a poorer outcome, the precise relationship between the time course of platelet counts and the mortality rate has not been well defined. OBJECTIVE: To describe the time course of the platelet count in relation to the mortality rate in critically ill patients. DESIGN: Substudy of a prospective, multicenter, observational cohort analysis. SETTING: Forty ICUs in 16 countries from Europe, America, and Australia. PATIENTS: Data were collected from all ICU admissions in a 1-month period, excluding patients younger than 12 yrs old and those who stayed in the ICU for <48 hrs after uncomplicated surgery. A total of 1,449 critically ill patients were enrolled, including 257 who stayed in the ICU for >2 wks. INTERVENTIONS: None. MEASUREMENTS: Platelet counts were collected daily throughout the ICU stay, together with other measures of organ dysfunction. Thrombocytopenia was defined as a platelet count of <150 x 103/mm3. A relative increase in platelet count was defined as a 25% increase above the admission value, together with an absolute platelet count of > or =150 x 103/mm3. MAIN RESULTS: For the entire population, the platelet count was lower in the 313 nonsurvivors than in the 1,131 survivors throughout the ICU course. Of the 257 patients who stayed in the ICU for >2 wks, 187 (64%) survived. The platelet count decreased significantly in the first days after admission to reach a nadir on day 4 in both survivors and nonsurvivors. In the survivors, the platelet count returned to the admission value by the end of the first week and continued to rise to become significantly greater than the admission value by day 9. In the nonsurvivors, the platelet count also returned to the admission value after 1 wk, but there was no subsequent increase in platelet count. A total of 138 (54%) patients had thrombocytopenia on day 4, and these patients had a greater mortality rate than the other patients (33% vs. 16%; p <.05). On day 14, 51 (20%) patients had thrombocytopenia, and these patients had a greater mortality rate than the other patients (66% vs. 16%; p <.05). Thrombocytopenia was less common on day 14 than on day 4 (20% vs. 54%; p <.05), but the mortality rate was greater in the thrombocytopenic patients on day 14 than those who were thrombocytopenic on day 4 (66% vs. 33%; p <.05). The ICU mortality rate of nonthrombocytopenic patients on day 14 was also significantly lower in patients with, than without, a relative increase in platelet count on day 14 (11% vs. 30%; p <.05). CONCLUSION: Platelet count changes in the critically ill have a biphasic pattern that is different in survivors and nonsurvivors. Late thrombocytopenia is more predictive of death than early thrombocytopenia. A relative increase in platelet count after thrombocytopenia was present in survivors but not in nonsurvivors. Although a single measured platelet count is of little value for predicting outcome, changes in platelet count over time are related to patient outcome.     

血小板数与巨核细胞、转化生长因子β1在川崎病动物模型中的动态变化

[目的]动态观察血小板数(PLT)、巨核细胞、转化生长因子β1(TGF-β1)在幼兔免疫性血管炎中的变化.[方法]用牛血清白蛋白复制幼兔免疫性血管炎的川崎病(KD)动物模型,每隔4 d分别检测血小板数、巨核细胞计数及分类、TGF-β1;并于d17、d28取冠状动脉、肝、脾、肾、脑等组织作病理学分析.[结果]PLT、巨核...     

急性脑梗死患者血小板改变及意义

目的：研究急性脑梗死患者血小板计数、体积、及其动态变化与脑梗死的关系。方法：用全自动细胞分析仪测定52例急性脑梗死患者的血小板计数PLT及血小板平均体积（MPV），对照组为30例健康志愿者。结果：脑梗死组的PLT显著低于对照组，MPV显著高于对照组，并呈动态变化；梗死面积与PLT呈负相关，与MPV成正相关。结论：血小板在血栓形成中起重要作用，检测血小板的计数及体积，对临床急性脑梗死的预防、梗死面积和病情判断有一定意义。     

Platelet function test HemoSTATUS 2: tool or toy for an optimized management of hemostasis?

BACKGROUND: Bleeding after open heart surgery is a common but unintended problem, which is unequivocally related to platelet function. The target of our study was to correlate platelet activation levels and postoperative blood loss as well as the predictive power of measurements focusing on postoperative hemostasis. MATERIALS AND METHODS: The prospective trial comprised 100 patients (mean age: 64.3 years, 68% male) undergoing cardiac surgery. Platelet activation was measured by the new and modified HemoSTATUS test. Blood samples were drawn pre-, intra- and postoperatively. Standard hemostasis tests, including activated clotting time (ACT), partial thromboplastin time (PTT), hemoglobin, platelet count, antithrombin III (AT III) and fibrinogen, were measured according to the clinical routine. Blood loss and consumed blood products were documented up to the 24th hour after the operation. RESULTS: Platelet activation showed a typical change, with lowest levels after the end of extracorporeal circulation and a restitution to preoperative levels after 24 h. Mean blood loss was 461 ml. Statistical analysis showed neither a correlation to the platelet activation measurements nor to low pre-, intra- or postoperative levels. CONCLUSION: The HemoSTATUS platelet function test is not suitable for a reliable monitoring of platelet pathophysiology and patient outcome after extracorporeal circulation. Furthermore, no correlation of preoperative platelet activation and blood loss could be shown.     

Phosphodiesterase-inhibitors enoximone and piroximone in cardiac surgery: Influence on platelet count and function

Objective Some phosphodiesterase (PDE)-inhibitors are believed to alter platelet count and function due to changes in intracellular cAMP. Whether newly developed (specific) PDE-inhibitors negatively influence platelet function in cardiac surgery should be investigated in a randomized study.Methods Eighty patients undergoing aorto-coronary bypass grafting were divided into 4 groups and received either the new PDE-III-inhibitor piroximone (group 1), the PDE-III-inhibitor enoximone (group 2), epinephrine (group 3) or no inotropic support (control). PDE-III-inhibitors were given as a bolus followed by infusion until starting of cardiopulmonary bypass (CPB). In addition to platelet count and a thrombelastogram, platelet function was assessed by aggregometry (ADP, epinephrine, collagen). Measurements were done before, during and after CPB until the 1st postoperative day.Results Platelet count and postoperative blood loss did not differ between the groups within the entire investigation period. Maximum aggregation and maximum gradient of platelet aggregation to all stimuli were not changed by either PDE-inhibitor enoximone or piroximone. CPB resulted in a significant decrease of all aggregation variables which was without differences due to treatment. Platelet aggregation recovered in the post-bypass period and exceeded baseline values on the 1st postoperative day.Conclusion It is concluded that enoximone and the new PDE-III-inhibitor piroximone do not affect platelet function and can be used before CPB without risking plateletrelated bleeding in cardiosurgical patients in the perioperative period.     

Diagnostic value of some markers of infection in cardiosurgical patients in the early postoperative period

The diagnostic value of traditional markers of infection and procalcitonin test (PCT) in the early postoperative period was compared in 60 cardiosurgical patients with acquired cardiac diseases and at risk for postoperative infectious complications. The mean age of the patients was 51 +/- 11 years. Preoperatively, all the patients had no signs of infections. The patients were examined before and on days 1, 2, 3, and 6 after surgery. Along with the routine studies (thermometry, general blood analysis), the plasma concentration of PCT was determined by immunoluminometric technique (LUMI-test PCT, Brahms Aktiengesellschaft, Germany). The preoperative level of PCT did not exceed the normal values ( < 0.5 ng/ml). On postoperative days 2 to 17, 14 (23.3%) patients developed infectious complications (Group 2); the other patients were included into a group of comparison (Group 1). Just within the first postoperative days, the levels of PCT were significantly higher in Group 2 patients than in Group 1 (7.58 +/- 2.34 and 3.51 +/- 0.71 ng/ml, respectively; p < 0.05). A difference was found in the count of white blood cells between the groups only from day 3. There were no significant differences in body temperature between the groups. At the second stage of analysis of the data, in accordance with the level of PCT on the first day after surgery and its subsequent changes, all the patients were divided into 4 groups (A-D). The level of PCT on postoperative day was less than 0.5 ng/ml in Group A (n = 6), 0.5-2 ng/ml in Group B (n = 23) and more than 2 ng/ml in groups C (n = 26) and D (n = 5). Subsequently, it was in the normal range in Group A, decreased to the normal values in Groups B and C by day 6 following surgery. The persistence of the high level of PCT was observed in Group D where there were the bulk (60%) of infectious complications. As compared with the traditional clinical and laboratory criteria (fever, leukocytosis), PCT is the earliest and most specific marker of bacterial infection in cardiosurgical patients in the early postoperative period. The level of PCT > 3.5 ng/ml within the first 24 hours after surgery is shown to be a predictor of postoperative infectious complications.     

经皮穴位电刺激预防肺癌患者化疗后骨髓抑制的效果观察

目的 探讨经皮穴位电刺激对预防肺癌患者化疗后骨髓抑制的效果。方法 选取102例初次化疗的非小细胞肺癌患者按照入院时间先后顺序分为实验组（n=47）和对照组（n=55）。实验组在常规护理基础上实施经皮穴位电刺激方法,对照组给予常规护理方法。 观察两组患者红细胞、白细胞、血小板、血红蛋白等主要反映骨髓抑制的指标以及患者舒适度。 结果 化疗第5天,实验组血小板计数显著高于对照组（P＜0.05）;第8天白细胞计数、血小板计数、舒适度评分显著高于对照组（P＜0.05）;第11天实验组血小板计数显著高于对照组（P＜0.05）;第14天实验组白细胞计数显著高于对照组（P＜0.05）。 结论 经皮穴位电刺激能预防肺癌化疗后骨髓抑制进程,并提高患者的舒适度,从而确保患者化疗顺利进行。     

新型网织红细胞参数在缺铁性贫血疗效观察中的应用

目的　观察网织红细胞绝对数 (RET #)、网织红细胞内血红蛋白量 (CHr)、平均网织红细胞体积 (MCVr)及网织红细胞内血红蛋白浓度 (CHCMr)等网红参数在缺铁性贫血 (IDA)患者铁剂治疗中的动态变化 ,确定骨髓对铁剂治疗反应的早期指标。方法　用Advia 12 0血细胞分析仪对 13例缺铁性贫血患者在治疗过程中网红参数的变化进行了动态观察。结果　缺铁性贫血患者在铁剂治疗后 ,网红参数RET #、CHr、MCVr于第 4天明显升高 (P <0 0 1) ,第七天恢复正常 ;血红蛋白于第 14天明显升高 (P <0 0 1) ,第 2 8天恢复正常 ;CH、MCV、CHCM于第 2 8天明显升高 (P <0 0 1) ,第 4 9天后恢复正常 ;RDW于第 7天明显升高 (P <0 0 1) ,14天后又逐渐降低 ,第 12 0天恢复正常。结论　网红参数RET #、CHr、MCVr可作为评价缺铁性贫血患者铁剂治疗后骨髓对治疗反应最敏感的指标