血小板计数与肝素耐药的相关性研究  

A Study of Correlation between Platelet Counts and Heparin Anticoagulant Deficiency

作　　者：彭敏建[1] 卢桂荣[2] 秦洋[1] 尹述洲[1] 

机构地区：[1]上海交通大学医学院苏州九龙医院麻醉科,江苏苏州215000 [2]上海交通大学医学院苏州九龙医院体外循环科,江苏苏州215000

出　　处：《医学与哲学（B）》2013年第11期42-43,79,共3页Medicine & Philosophy(B)

基　　金：江苏省自然科学基金资助课题;项目编号:BK2009139

摘　　要：研究心脏手术中的血小板(PLT)计数与肝素耐药的相关性。随机将120例行心脏手术患者根据PLT计数分成低血小板组(PLT<150×109·L-1)和高血小板组(PLT>250×109·L-1),每组各60例。麻醉后抽取中心静脉血监测激活凝血时间(ACT)基础值,肝素化后ACT值,肝素总用量和鱼精蛋白用量,并计算鱼精蛋白/肝素用量。首次肝素化后静脉血ACT值两组间差异无统计学意义。但两组ACT基础值差异有统计学意义(P<0.05)。高血小板组肝素抗凝不足者有26例(43.3%),低血小板组仅4例(6.67%),两组间差异有统计学意义(P<0.01)。肝素及鱼精蛋白用量均有统计学意义,前者用量较大(P<0.01)而后者用量较少(P<0.05)。心脏手术时血小板计数高者易出现肝素抗凝不足。肝素需要量较大而鱼精蛋白用量较少。高血小板组以先心病患儿为多。To investigate the correlation between platelet counts and heparin anticoagulant deficiency in open heart surgery. 120 cardiac surgical patients were randomly divided into group A （platelet counts 〈150× 10^9 · L^-1,n=60） and group B （platelet counts〉250 X 10^9 · L^-1,n= 60 ）. Blood samples from CVP catheter were taken to measure activated clotting time （ACT） at the following points： before heparinization and 5 minutes after heparinization. The requirements of heparin and protamine were recorded and protamine/heparin ratios were calculated. The baseline of ACT in group B was lower than in group A （P〈0.05）. In Group B, twenty-six patients showed relative heparin anticoagulant deficiency （43.3 G ）, and four patients in group A （6.67G）（P〈0.01）. The dosage of protamine in group B was less than that in group A . There was a statistically significant increase of heparin anticoagulant deficiency in patients with platetlet counts than 250 ×10^9 L^-1 during open heart surgery . In patients with higher platelet counts, the requirements of heparin were larger but than of protamine were smaller. Most of them were pediatric congenital heart disease.

关 键 词：心脏手术 血小板计数 肝素抗凝不足 

分 类 号：R654.2[医药卫生—外科学]