摘要
目的探讨新鲜血小板联合血凝酶对口服阿司匹林脑出血患者术后再出血的预防治疗作用。方法将符合标准的口服阿司匹林脑出血患者随机分为联合治疗组（23例）、单纯治疗组（23例），将同期符合标准的未口服阿司匹林脑出血患者（18例）作为对照组。3组患者均急症行小骨窗开颅血肿清除术，术前、术中、术后给予血凝酶治疗。联合治疗组术前、术后给予新鲜血小板治疗。检测治疗前后残余血肿量、引流量、血小板聚集率、血小板黏附率、凝血酶原时间、活化部分凝血活酶时间。结果治疗前患者血肿量：联合治疗组为（53±11）ml，单纯治疗组为（51±13）ml，对照组为（50±15）ml，3组比较差异无统计学意义（F=0．29，P〉0．05）；联合治疗组血小板聚集率[（43．6±6．2）％]、血小板黏附率[（41．6±8．5）％]与单纯治疗组血小板聚集率[（43．1±5．0）％]、血小板黏附率[（42．7±8．9）％]明显低于对照组血小板聚集率[（65．2±6．1）％]、血小板黏附率[（64．3±9．1）％]，差异均有统计学意义（F值分别为92．93、40．93，P均〈0．05）。治疗后1d，联合治疗组残余血肿量[（7±4）m1]、引流量[（301±21）m1]明显低于单纯治疗组残余血肿量[（19±5）m1]、引流量[（413±26）m1]（P均〈0．05）；联合治疗组血小板聚集率[（64．8±5．7）％]、血小板黏附率[（63．3±6．6）％]，明显高于单纯治疗组血小板聚集率[（51．6±3．7）％]、血小板黏附率[（50．3±7．8）％]，差异均有统计学意义（P均〈0．05）；与对照组血小板聚集率[（68．1±5．9）％]、血小板黏附率[（67．4±9．5）％]相比差异均无统计学意义（P均〉0．05）。结论新鲜血小板联合血凝酶可以明显改善口服阿司匹林脑出血患者的凝血功能，减少术后再出血的发生。
Objective To investigate the effects of fresh isolated platelets combined with hemocoagulase on treating and preventing rehaemorrhagia after operation in the patients with cerebral hemorrhage who treated with aspirin. Methods Forty-six patients with cerebral hemorrhage who treated with aspirin were divided into combined therapy group （ n = 23 ） and simple therapy group （ n = 23 ）. Eighteen patients with no aspirin treated were as control group. All patients were received the same basic treatment of small bone flap craniotomy and hemocoagulase. Moreover, patients in combined therapy group were treated with fresh isolated platelets before and after operation. The remained haematoma volume, the volume of draining, platelect aggregation rate, platelet adhesion rate, prothrombin time and activated partial thromboplastin time were measured before and after treatment respectively. Results Before treatment,the haematoma volume were（53 ± 11 ） ml, （51 ± 13 ） ml, （50± 15） ml in combined therapy group, basic therapy group and control group respectively, and no significant difference was found among the three groups（ F = 0. 29, P 〉 0. 05 ）. The rate of platelet aggregation and the rate of platelet adhesion in combined treatnnet group were （ 43.6 ± 6. 2 ） % and （ 41.6 ± 8. 5 ） % , and （ 43.1 ± 5.0） %, （ 42. 7 ±8.9 ） % in simple group, significantly lower than that in control group （ （ 65.2 ± 6. 1 ） %, 64. 3 ±9. 1 ） %. F = 92. 93,40. 93, P 〈 0. 05 ） ）. At 1 st day after treatment, the remained haematoma volume and the volume of draining in combined therapy group were（7 ± 4） ml and （301 ±21 ） ml, significantly lower than that in simple therapy group （ （ 19 ± 5 ） ml, （ 413 ± 26 ） ml, P 〈 0.05 ）. While the rate of platelet aggregation （ 64. 8± 5. 7 ） % and the rate of platelet adhesion （ 63. 3 ± 6. 6 ） % in combined therapy group were significantly higher than that in simple therapy group （ （ 51.6 ± 3.7 ） %, （ 50. 3 ± 7.8 ） %, P 〈 0. 05 ）. And compared to control group （ （ 68.1 ± 5.9 ） %, （ 67.4 ± 9. 5 ） % ）, there were no significant difference between combined therapy group and control group（P 〉 0. 05）. Conclusion Fresh isolated platelets combined with hemocoagulase can improve the function of blood clotting and reduce rehaemorrhagia after operation in the patients with cerebral hemorrhage who treated with aspirin.
出处
《中国综合临床》
2013年第12期1301-1304,共4页
Clinical Medicine of China
关键词
脑出血
阿司匹林
血凝酶
新鲜血小板
术后再出血
Cerebral hemorrhage
Aspirin
Hemocoagulase
Fresh platelets
Rehaemorrhagia after operation
