Deodhar M, Kakkar N
Department of Surgery, Christian Medical College and Hospital, Ludhiana-141 008, Punjab, India.
J Clin Pathol. 2004 Apr;57(4):407-10. doi: 10.1136/jcp.2003.013896.
Patients with an absent or dysfunctional spleen are at risk of infection by encapsulated and other bacteria. Overwhelming postsplenectomy infection (OPSI) causes most concern because it can result in significant mortality. A retrospective review of splenectomised patients in a tertiary care setting over an eight year period was carried out to determine whether current postsplenectomy guidelines were being followed.
The cases were identified from the medical records and pathology files and data such as the reason for splenectomy, the preventive measures taken regarding vaccination, and antibiotic prophylaxis, together with their documentation in the discharge notes were assessed.
Fifty six patients were studied. Trauma, both blunt and penetrating, was the most common reason for splenectomy. Thirty six patients received pneumococcal vaccination, with 20 patients having no mention of vaccination in their case notes. The discharge notes of 50 patients mentioned their splenectomised status; however, documentation of vaccination details in the discharge summary was poor, with only three patients having the relevant information recorded. Documentation of the need for future vaccination and precautions required in the asplenic condition was also lacking. Nine patients had postsplenectomy complications, although there were no cases of OPSI.
Adherence to standard guidelines for the management of splenectomised patients was unsatisfactory. There is a need for an improvement of the vaccination rate and careful documentation of this important health risk in the discharge summaries. Maintenance of a splenectomy registry could aid in optimising the management of these patients.
无脾或脾功能不全的患者有感染包膜菌和其他细菌的风险。脾切除术后暴发性感染（OPSI）最令人担忧，因为它可能导致显著的死亡率。对一家三级医疗机构八年期间行脾切除术的患者进行回顾性研究，以确定当前的脾切除术后指南是否得到遵循。
从病历和病理档案中识别病例，并评估诸如脾切除原因、疫苗接种和抗生素预防等预防措施，以及出院记录中的相关记录。
共研究了56例患者。钝性和穿透性创伤是脾切除最常见的原因。36例患者接受了肺炎球菌疫苗接种，20例患者的病例记录中未提及疫苗接种。50例患者的出院记录提到了他们的脾切除状态；然而，出院小结中疫苗接种细节的记录很差，只有3例患者记录了相关信息。也缺乏关于未来疫苗接种需求和无脾状态所需预防措施的记录。9例患者出现脾切除术后并发症，尽管没有OPSI病例。
对脾切除患者的标准管理指南的遵循情况不尽人意。需要提高疫苗接种率，并在出院小结中仔细记录这一重要健康风险。维持脾切除术登记册有助于优化这些患者的管理。
