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目的观察血液病患者输注机采血小板的治疗效果,探讨白细胞过滤及γ射线照射在预防血小板输注无效(PTR)中的作用。方法 759例患者每次输注机采血小板前1 h和输注后24 h检查靜脉血小板数量,计算血小板计数纠正增加指数(CCI),以输注后24 h CCI<4.5×109·L-1为PTR;发生PTR的患者,在再次输注血小板前,分别进行67例次的白细胞过滤和81例次的γ射线照射,其中,有26例次的血小板联合应用了这2项技术。结果 3 467例次输注新鲜机采血小板,无效率1 222/3 467,35.25%。免疫性血小板减少症(ITP)组的PTR发生率最高49.35%;机采血小板输注次数、累积剂量与输注效果比较,血小板量10 U,无效率26.2%;20 U,无效率51.72%;≥30 U,无效率73.58。20 U与10 U,≥30 U与10 U、20 U与≥30 U比较,χ2分别为38.56、106.46、14.29,P均<0.05。白细胞过滤、γ射线照射及γ射线照射联合白细胞过滤后的PTR发生率分别是19.51%(8/41)、20.00%(11/55)和3.85%(1/26),P均>0.05,但三者与未经治疗前患者的PTR发生率比较有显著差异(P<0.05)。结论 PTR的发生随患者疾病的不同而不同,ITP患者的PTR发生率最高;PTR的发生与患者血小板输注剂量有关,输注剂量越大,发生PTR的机率越大;白细胞过滤、γ射线照射等对预防PTR有明显效果。
Objective To observe the therapeutic effect of platelet transfusion in patients with hematological diseases and to explore the role of leukocyte filtration and γ-ray irradiation in preventing platelet transfusion ineffectiveness (PTR). Methods The number of venous platelets in 759 patients was measured 1 h before platelet transfusion and 24 h after transfusion. The corrected platelet count index (CCI) was calculated. CCI <4.5 × 109 · L -1 PTR; patients with PTR before the re-infusion of platelets, respectively, 67 cases of leukocyte filtration and 81 cases of γ-ray irradiation, of which, 26 cases of platelet combination of these two technologies. Results A total of 3 467 cases of freshly taken platelets were collected, with inefficiencies of 1 222/3 467 and 35.25%. The incidence of PTR was the highest in immunotope thrombocytopenia (ITP) group, the highest was 49.35%. The number of platelet transfusion, cumulative dose and cumulative dose were 10 U, 26.2%, 20 U, 51.72% Χ2 = 38.56, 106.46, 14.29, respectively, P <0.05, ≥30 U, inefficiency 73.58.20 U and 10 U, ≥30 U and 10 U, 20 U and ≥30 U, respectively. The incidence of PTR after leukocyte filtration, γ-ray irradiation and γ-ray irradiation combined with leukocyte filtration were 19.51% (8/41), 20.00% (11/55) and 3.85% (1/26) respectively, all P> 0.05 There was a significant difference in the incidence of PTR between the three groups and those before treatment (P <0.05). Conclusions The occurrence of PTR varies with the patient’s disease. The incidence of PTR in ITP patients is the highest. The incidence of PTR is related to the platelet transfusion dose. The larger the infusion dose, the greater the incidence of PTR. The leukocyte filtration and γ-ray irradiation And so on the prevention of PTR have a significant effect.