术前血小板计数对体外循环患者激活全血凝固时间的影响  

Effect of platelet counting on active clotting time in patients undergoing cardiac surgery during extracorporeal circulation

作　　者：林梓霞[1] 黄小萌[1] 林映华[2] 马楚洲[1] 

机构地区：[1]汕头市中心医院麻醉科,广东汕头515031 [2]汕头市中心医院手术室,广东汕头515031

出　　处：《岭南心血管病杂志》2013年第3期306-309,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨体外循环下行心内直视手术患者术前血小板(platelet,PLT)计数对其激活全血凝固时间(active clotting time,ACT)的影响。方法回顾性分析汕头市中心医院2008～2012年共410例体外循环心脏手术患者的临床资料,根据PLT计数和年龄分为4组:I组为PLT<240×109/L,年龄<14岁;II组为PLT<240×109/L,年龄>14岁;Ⅲ组为PLT>240×109/L,年龄<14岁;Ⅳ组为PLT>240×109/L,年龄>14岁。4组肝素化后5～10 min抽取中心静脉血测定ACT。ACT>480 s为抗凝满意;ACT<480 s为肝素相对耐药;如追加肝素至50～60 mg/kg后ACT仍达不到480 s,则为肝素耐药。结果Ⅳ组与Ⅱ组相比,ACT明显缩短,差异有统计学意义[(726.12±201.93)s vs.(837.02±150.54)s,P<0.05];且肝素相对耐药(ACT<480 s)发生率明显增高,差异有统计学意义[13.2%(11/83)vs.1.1%(2/187),P<0.05]。Ⅲ组与I组ACT比较,差异无统计学意义(P>0.05)。结论术前PLT计数增高且年龄>14岁的患者,容易引起ACT缩短,引发肝素相对耐药的可能性较大。而年龄<14岁,即使PLT计数偏高,也较少出现肝素耐药。Objectives To discuss the effect of platelet （PLT） counting on active clotting time （ACT） in patients undergoing cardiac surgery during cardiopulmonary bypass. Methods Retrospective analysis of 410 cases undergoing cardiac surgery from 2008 to 2012 in Central Hospital of Shantou was performed. All patients were divided into 4 groups according to their preoperative PLT counting and age： group I with PLT〈240×10^9/L （aged 1 to 14）, group II with PLT〈240×10^9/L （aged more than 14）, group Ⅲ with PLT〉240×10^9/L （aged 1 to 14）, group IV with PLT〉240×10^9/L （aged more than 14）. ACT level from central venous blood was monitored in 5-10 min after heparinization. ACT more than 480 s was safe for anticoagulation, and less than 480 s was considered as relative resistance of heparin. Heparin resistance was that ACT could not be extended to 480 s after heparin was added to 50-60 mg/kg. Results ACT in group IV was significantly shorter than that in group Ⅱ [（726.12±201.93）s vs. （837.02±150.54）s,P〈0.05]. Meanwhile, incidence of relative heparin resistance （ACT〈480 s） obviously increased in group IV than that in group Ⅱ [ 13.2% （11/83） vs. 1.1% （2/187）, P〈0.05]. There was no significant difference of ACT in group III compared with group I （P〉0.05）. Conclusions Patients with a higher PLT counting and aged more than 14 may have more risk of suffering from shortened ACT and relative heparin resistance. On the contrary, heparin resistance happens rarely in patients aged less than 14, even with a higher PLT counting.

关 键 词：体外循环 血小板 激活全血凝固时间 肝素 

分 类 号：R654.1[医药卫生—外科学]