Perkins A C, Joshua D E, Gibson J, Kronenberg H
Haematology Department, Royal Prince Alfred Hospital, Camperdown, NSW.
Med J Aust. 1988 Jan 4;148(1):44-6. doi: 10.5694/j.1326-5377.1988.tb104485.x.
The vital role of a normally-functioning spleen in a host's defence against circulating microorganisms has been realized for many years. The fulminant clinical course that characterizes infection with encapsulated microorganisms in asplenic patients is highlighted in these cases of severe pneumococcal sepsis in two patients, 10 and 13 years after splenectomies for idiopathic thrombocytopenic purpura. Approaches to the acute management of septic episodes and preventive measures are discussed. Pneumococcal vaccination reduces the incidence of infection effectively in asplenic patients and has a low complication rate. Penicillin by mouth is also efficacious in this situation, but patient compliance is low. Our current practice is to offer pneumococcal vaccination to all patients who have undergone splenectomy in the past and to administer the vaccine two weeks before elective splenectomies. Asplenic patients should be educated about the potential dangers of a septic episode and should be urged to seek an early medical consultation when this occurs.
正常运作的脾脏在宿主抵御循环微生物方面的重要作用已被认识多年。在两名因特发性血小板减少性紫癜行脾切除术后10年和13年发生严重肺炎球菌败血症的病例中，突显了无脾患者感染包膜微生物所具有的暴发性临床病程。文中讨论了败血症发作的急性处理方法及预防措施。肺炎球菌疫苗接种可有效降低无脾患者的感染发生率，且并发症发生率低。口服青霉素在这种情况下也有效，但患者依从性低。我们目前的做法是为所有既往接受过脾切除术的患者提供肺炎球菌疫苗接种，并在择期脾切除术前两周接种疫苗。应告知无脾患者败血症发作的潜在危险，并敦促他们在出现这种情况时尽早寻求医疗咨询。
