年龄对法乐四联症患儿体外循环期间凝血功能的影响  

Effect of age on the coagulation function in children with tetralogy of Fallot

作　　者：黄延辉 陈煜[1] 徐美英[2] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心麻醉科,200127 [2]上海交通大学附属胸科医院麻醉科

出　　处：《上海医学》2012年第2期101-104,共4页Shanghai Medical Journal

基　　金：上海市级医院适宜技术联合开发推广应用项目资助(SHDC12010222)

摘　　要：目的观察年龄对法乐四联症患儿体外循环(CPB)期间凝血功能的影响。方法择期在CPB下行心脏直视手术矫正法乐四联症的患儿24例,按年龄分为A组(年龄≤12个月)、B组(年龄>12个月但≤24个月)和C组(年龄>24个月但≤5岁),每组8例。麻醉诱导后即刻(CPB前)和鱼精蛋白中和肝素10min后(CPB后)自颈内静脉抽血,采用池珠法测定凝血因子Ⅹ、Ⅶ的活性,酶联免疫吸附试验(ELISA)吸附双抗体夹心法测定血小板α-颗粒膜蛋白(GMP-140)水平,同时测定凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)及血小板计数,并用Sonoclot凝血与血小板功能分析仪检测激活凝血时间(SonACT)、凝集速率(ClotRate)和血小板功能(PF)。结果 3组间在CPB前的各项检测指标的差异均无统计学意义(P值均>0.05)。CPB后,与B、C组相比,A组的SonACT显著延长(P值均<0.01),PF显著增强(P值均<0.01),GMP-140水平显著降低(P值分别<0.05、0.01)。与同组CPB前比较,3组在CPB后的凝血因子Ⅹ活性均显著减弱(P值均<0.01),SonACT、PT、APTT均显著延长(P值分别<0.05、0.01),血小板计数显著减少(P值均<0.01);A组和B组的凝血因子Ⅶ活性、B组的Clot Rate和PF、C组的PF均显著减弱(P值分别<0.05、0.01),B组和C组的GMP-140水平显著升高(P值分别<0.05、0.01)。结论 CPB削弱了患儿的凝血功能。法乐四联症患儿CPB后的凝血功能与年龄有关,年龄≤12个月患儿的血小板反应性低于年龄>12个月的患儿。Objective To explore the effect of age on coagulation function during cardiopulmonary bypass（CPB） in children with tetralogy of Fallot. Methods According to their different ages,24 children with tetralogy of Fallot,who underwent elective CPB,were divided into group A（≤1 year,n =8）,group B（1 to 2 years,n=8） and group C（≥2 to 5 years,n=8）.Blood samples of internal jugular vein were drawn after anesthesia induction and 10 minutes after protamine administration.The activity of clotting factor Ⅹ and Ⅶ was measured by magnetic bead method.Platelet α-granule membrane protein（GMP-140）,prothrombin time（PT）,activated partial thromboplastin time（APTT） and platelet count were detected by enzyme linked immunosorbent assay（ELISA）.Activated clotting time（SonACT）,clot rate and platelet function（PF） were measured by Sonoclot analysator. Results The differences of baseline measurements had no statistic significance among groups（P0.05）.Compared with groups B and C,the SonACT was significantly extended（P0.01）,PF was increased（P0.05,0.01）,and GMP-140 was decreased（P0.05,0.01） after CPB in group A.Compared with before CPB,the activity of clotting factor Ⅹand platelet count were significantly decreased（P0.01）,and SonACT,PT and APTT were significantly increased（P0.05,0.01） in the three groups after CPB;the activity of clotting factor Ⅶ in groups A and B and GMP-140 in groups B and C were significantly increased after CPB（P0.05,0.01）,and clot rate in group B and PF in groups B and C were significantly decreased（P0.05,0.01）. Conclusion The coagulation function of pediatric patients is impaired after CPB and is related to age.The platelet reactivity is lower in younger infants ≤12 months compared with the elder children after CPB.

关 键 词：年龄 心肺转流术 血液凝固 先天性心脏病 

分 类 号：R726.1[医药卫生—儿科]