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特发性血小板减少性紫癜以眼科症状为首诊一例

血小板减少症患者的心瓣膜置换术

目的总结合并血小板减少症的患者接受心瓣膜置换术的治疗经验,并探讨其可行性。方法对28例心脏瓣膜病合并血小板减少症患者施行心瓣膜置换术,入院时血小板为23×109/L～50×109/L(42.00×109/L±7.41×109/L),所有患者均使用膜肺并在预充液中分别加入300×104U～500×104U的抑肽酶。行二尖瓣置换术12例,主动脉瓣置换术8例,双瓣膜置换术8例;转流结束以鱼精蛋白中和肝素后立即输注新鲜血小板13～27U(17.8±3.9U)。结果3例术后12h内因胸腔引流管引流量大而行二次开胸探查,1例术后3d死于心室颤动,其余患者均治愈出院。结论加强术中处理,可以使血小板数维持于20×109/L～50×109/L的心脏瓣膜病合并血小板减少症的患者安全接受心瓣膜置换术。

维持性血液透析患者感染新型冠状病毒后并发免疫性血小板减少一例

干燥综合征患者产后血栓性血小板减少性紫癜出现急性心力衰竭一例

乙二胺四乙酸依赖的假性血小板减少症一例

Clinical Observation on Recombinant Human Thrombopoietin Treating Chemotherapy-induced Thrombocytopenia

【摘要】 目的 评价重组人血小板生成素（rhTPO）治疗肿瘤化疗后血小板减少的疗效和安全性。 方法 2008年12月-2009年10月收住恶性肿瘤患者45例，在化疗后出现血小板减少，随机分为A、B组，A组皮下注射rhTPO（15 000 U/d），B组皮下注射白细胞介素-11（1.5 mg/d），动态监测注射后血小板生长情况。 结果 A组血小板计数的最低值明显高于B组（Plt;0.05）；A组血小板开始恢复时间较B组明显缩短（Plt;0.01）；血小板恢复至100×109/L以上所需时间A组较B组明显缩短（Plt;0.05），分别为（6.18±4.20）和（10.46±4.54） d，血小板恢复的最高值两组差异无统计学意义（Pgt;0.05）；B组有2例患者化疗后需要输入外源性血小板，A组无患者需要输入血小板；与B组比较，A组较少发生不良反应，患者可以耐受。 结论 重组人血小板生成素是一种治疗化疗后出现血小板减少的有效方法。【Abstract】 Objective To evaluate the therapeutic effect of recombinant human thrombopoietin (rhTPO) on chemotherapy-induced thrombocytopenia. Methods Forty-five in-patients with malignant tumor from December 2008 to October 2009 who had thrombocytopenia after chemotherapy were randomly divided into A and B groups. The patients in group A underwent the hypodermic injection with rhTPO (15 000 U/d) while in group B with interleukin-11 (1.5 mg/d);the platelet count was checked consecutively. Results Compared with that in group B, the platelet count was obviously higher (Plt;0.01) and the time of declined platelet count beginning to recover was significantly shorter in group A. The time of platelet count increasing to 100×109/L was within (6.18±4.20) days in group B which was significantly shorter than (10.46±4.54) days in group B (Plt;0.05). However, no significant was found between the two groups in the maximal platelet count (Pgt;0.05). Two patients needed platelet transfusion in group B and no one did in group A. Conclusion rhTPO is safe and effective for chemotherapy-induced thrombocytopenia.

Clinical Observation of Splenectomy on Chronic Idiopathic Thrombocytopenic Purpura

ObjectiveTo study the results of splenectomy in patients with idiopathic thrombocytopenic purpura. MethodsSeven patients who failed to respond to conservative management were treated with splenectomy and followed up for 6 months to 8 years (1990～1999).ResultsThe presplenectomy patients had symptoms of bleeding and their platelet count on average was 32×109/L. The 3th,7th day and 1th,2th, 6th month after splenectomy, the average platelet count was 191×109/L,354×109/L,317×109/L,200×109/L and 151×109/L respectively. Their platelet recovered to normal during a week in 7 cases (≥100×109/L); In 6 patients the platelet count was normal in the 6th month after splenectomy, the success rate was 6/7, the rate of remission was 1/6. The platelet count after splenectomy was significantly higher than that before splenectomy.ConclusionThere are no correlation between the course of disease before splenectomy and the results of splenectomy. Splenectomy is safe and effective in the treatment of idiopathic thrombocytopenic purpura.

腹腔镜脾切除术治疗特发性血小板减少性紫癜的护理

【摘要】 目的 〖JP2〗总结腹腔镜脾切除术治疗特发性血小板减少性紫癜患者围手术期的护理。 方法 2005年11月-2008年6月，对40例行腹腔镜脾切除术治疗特发性血小板减少性紫癜患者，在术前、术后予以精心护理，并针对患者个体及各种征状，采取积极有效的护理措施，防止各种并发症发生。 结果 38例患者顺利康复出院；1例术后出血，经积极治疗后治愈出院；1例发生左下肢深静脉血栓，经抗凝溶栓治疗后好转出院。 结论 有效的围手术期护理能降低腹腔镜脾切除术后并发症的发生，减轻患者的痛苦，促进患者早期康复。

Analysis on the Correlation of Thrombopoietin and Anti-thrombopoietin Antibody with Thrombocytopenia in Patients with Primary Sjören Syndrome

ObjectiveTo analyze the correlation of thrombopoietin (TPO) and anti-TPO antibody with thrombocytopenia in patients with primary Sjögren syndrome (PSS). MethodsWe included in our study 40 PSS patients with thrombocytopenia (group A), 22 PSS patients who once had thrombocytopenia and returned to normal (group B), 40 PSS patients with normal platelet counts (group C) and 40 healthy controls (group D) between September 2013 and October 2014. Anti-TPO antibody was detected by indirect enzyme-linked immunosorbent assay (ELISA), and serum TPO levels were measured by ELISA. We analyzed the relationship between the assay results and the clinical manifestations and parameters. ResultsThe serum TPO levels in groups A, B, and C were (129.74±17.47) , (330.23±18.07) and (364.19±12.25) pg/mL, respectively, and they were significantly higher than that in group D [(54.04±10.71) pg/mL] (P ＜ 0.05) . The serum level of TPO was positively correlated with CRP and IgA (rs=0.224, P=0.039; rs=0.239, P=0.033) , and was negatively correlated with C4 level (rs=?0.220, P=0.041) , but it was not significantly correlated with platelet count, erythrocyte sedimentation rate, the level of antiphospholipid antibodies and the titer of antinuclear antibodies (P ＞ 0.05) . The positive rate of PSS patients was 20.59% (21/102) and the rate in groups A, B, and C was respectively 17.5% (7/40) , 22.72% (5/22) , and 22.5% (9/40) . There was no statistically significant difference between the positive and negative groups in various clinical indexes (P ＞ 0.05) . ConclusionAntiTPO antibody may not be the main mechanism of thrombocytopenia in PSS patients, and there is a certain correlation between TPO and inflammatory factors.

Laparoscopic Splenectomy for Idiopathic Thrombocytopenic Purpura in 20 Cases

目的　探讨腹腔镜下脾切除术（LS）治疗特发性血小板减少性紫癜(ITP)的临床效果。方法　我院2003年1月至2008年8月期间行LS治疗ITP患者20例，将术前与术后1、2、7、14、30、90及180 d的血小板计数进行比较。结果　20例ITP患者均顺利完成LS，平均手术时间为156 min，术中出血平均50 ml，平均住院时间为9 d。完全停用药物14例； 4例患者术后需继续服用激素治疗，但激素用量较前明显减少； 无效2例。总有效率为90%。术后1、2、7、14、30、90及180 d的血小板数量分别为(251.6±91.4)×109/L、(312.6±90.1)×109/L、(343.2±103.7)×109/L、(300.0±98.2)×109/L、(175.6±42.6)×109/L、(151.8±42.1)×109/L及(207.0±53.4)×109/L,分别与术前〔(38.3±19.4)×109/L〕比较，经t检验，差异均有统计学意义（P＜0.001）。结论　LS治疗ITP是可行和安全的，手术效果满意。