Sunami H, Nawa S, Nakata T, Hirata S, Yoshitomi I, Miyachi Y, Hayashi K
Cardiovascular Devision, Junkankika-Hayashi Hospital, Niihama, Japan.
Kyobu Geka. 1993 Jun;46(6):486-8.
The aortic and mitral valve replacements were successfully performed in a case with idiopathic thrombocytopenic purpura. High-dose-gamma-globulin therapy and splenectomy had been tried. Neither of them, however could increase thrombocyte. After administration of Danazol treatment, thrombocytes moderately increased. With no expectation for further increase in thrombocytes, it was decided to carry out the open heart surgery with the aid of transfusion of thrombocyte-rich fresh plasma. Haemostasis after cardiopulmonary bypass required much longer time as 3 hours than in usual cases, but being successfully controlled. It has been reported that the effectiveness rate of the high-dose-gamma-globulin therapy ranges from 80 to 90%. Therefore this strategy will be the first choice in a case with ITP requiring open heart surgery. In the event that the strategies, including splenectomy, failed, other means such as Danazol therapy and transfusion of thrombocyte-rich fresh plasma should be considered.
在一例特发性血小板减少性紫癜患者中成功进行了主动脉瓣和二尖瓣置换术。此前已尝试过大剂量γ球蛋白治疗和脾切除术，但均未能增加血小板数量。给予达那唑治疗后，血小板数量适度增加。由于预计血小板数量不会进一步增加，因此决定在输注富含血小板的新鲜血浆的辅助下进行心脏直视手术。体外循环后的止血时间比通常情况长3小时，但最终成功控制。据报道，大剂量γ球蛋白治疗的有效率在80%至90%之间。因此，该策略将是需要进行心脏直视手术的特发性血小板减少性紫癜病例的首选。如果包括脾切除术在内的策略失败，则应考虑其他方法，如达那唑治疗和输注富含血小板的新鲜血浆。
