外伤性脾破裂患者及肝硬变患者脾切除术后血小板变化情况研究

目的比较外伤性脾破裂患者与肝硬变门静脉高压症患者脾切除术后血小板变化的差异,分析可能的原因及其临床意义。方法统计我院2008年7月至2009年12月期间47例外伤性脾破裂患者及36例肝硬变患者行脾切除术前后的血小板计数,比较脾切除术后2组患者血小板计数及其变化趋势的差异。结果脾破裂组47例患者术后均出现血小板异常升高,血小板计数最高值300×109/L～600×109/L者6例,600×109/L～900×109/L者21例,>900×109/L者20例;肝硬变组36例患者中有26例术后血小板最高值超过300×109/L,8例在100×109/L～300×109/L之间,2例仍低于100×109/L。2组患者术后血小板最高值分布的差异具有统计学意义(P=0.00)。脾破裂组患者与肝硬变组患者相比,术后血小板升高更明显,下降更缓慢(P<0.05)。Child A级患者血小板异常的持续时间及血小板升高幅度均超过Child B、C级患者(P=0.006,P=0.002)。结论脾破裂和肝硬变患者,因肝功能及全身状况的差异,术后血小板数量的变化有明显的不同。术后应根据血小板计数及凝血功能情况采取相应的治疗,方可取得良好的治疗效果。

Research of Changes of Platelet Count after Splenectomy in Patients with Splenic Rupture or Cirrhosis

Objective To compare the difference of the changes of platelet counts after splenectomy between the patients with splenic rupture and patients with cirrhosis and portal hypertension,and to analyze the possible reasons and clinical significance.Methods The platelet count of 47 splenic rupture patients and 36 cirrhosis patients who had been carried out splenectomy from July 2008 to December 2009 in our hospital were counted,and the differences in platelet count and it’s change tendency of two groups were compared.Results In the splenic rupture group,the platelet count of all 47 patients increased abnormally after operation,the maxlmum value of platelet count among 300×109/L-600×109/L in 6 cases,600×109/L-900×109/L in 21 cases,and above 900×109/L in 20 cases.In the cirrhosis group,the maxlmum value of platelet count after operation was above 300×109/L in 26 cases,100×109/L-300×109/L in 8 cases,and below 100×109/L in 2 cases.The difference of maxlmum value of platelet count in the two groups had statistic significance(P=0.00).Compared with the cirrhosis group,the platelet count increased more significant and decreased more slow in splenic rupture group(P<0.05).The abnormal days and rising range of platelet count were higher in patient with Child A than Child B and C(P=0.006,P=0.002).Conclusions The change of platelet count after operation in splenic rupture group was obviously different from cirrhosis group because of the difference of the liver function and body situation of patients.To patients with splenic rupture or cirrhosis,appropriate treatment based on the platelet count and liver function could obtain good therapeutic effect.