Okada Y, Hino H, Nagahama H, Kinouchi H, Sakamoto M, Aoki T
Department of Anesthesiology, St. Marianna University School of Medicine, Kawasaki.
Masui. 1997 Nov;46(11):1470-3.
Case 1. The patient was a 69-year-old man with essential thrombocythemia (ET), who underwent urgent laparotomy. On admission he was dehydrated and the platelet count was more than 160 x 10(4).microliter-1, with hematocrit of 50%. Anesthesia was induced with ketamine i.v. and maintained with nitrous oxide and sevoflurane in oxygen. Postoperative care included the administration of gabexate mesilate (GM) which is an antiplatelet agent. Case 2. An 84-year-old woman with ET was diagnosed as gastric cancer and elective gastrectomy was scheduled. The platelet count was more than 100 x 10(4).microliter-1. The patient was anesthetized with nitrous oxide and oxygen supplemented with fentanyl and mepivacaine via epidural catheter. Intravenous infusion of GM was performed at a rate of 1 mg.kg-1.hr-1 during surgery. PF-4 and beta-TG were measured. These are platelet releasing factors. The level of PF-4 decreased to normal level during this procedure. In conclusions, it will be important to use GM during anesthesia in order to avoid the complications such as myocardial or pulmonary infarction caused by thrombocythemia.
病例1. 患者为一名69岁患有原发性血小板增多症（ET）的男性，接受了紧急剖腹手术。入院时他处于脱水状态，血小板计数超过160×10⁴/微升，血细胞比容为50%。静脉注射氯胺酮诱导麻醉，并用氧化亚氮和七氟醚在氧气中维持麻醉。术后护理包括给予甲磺酸加贝酯（GM），这是一种抗血小板药物。病例2. 一名84岁患有ET的女性被诊断为胃癌，计划进行择期胃切除术。血小板计数超过100×10⁴/微升。患者通过硬膜外导管给予氧化亚氮和氧气，并补充芬太尼和甲哌卡因进行麻醉。手术期间以1毫克/千克·小时⁻¹的速率静脉输注GM。检测了PF-4和β-TG。这些是血小板释放因子。在此过程中PF-4水平降至正常水平。总之，在麻醉期间使用GM对于避免因血小板增多症引起的心肌梗死或肺梗死等并发症很重要。
