动脉导管未闭封堵术后严重血小板减少的危险因素及早期诊断  

Risk factors and early diagnosis of severe thrombocytopenia complicating transcatheter occlusion of a patent ductus arteriosus

作　　者：张坡[1] 朱鲜阳[1] 张端珍[1] 王琦光[1] 韩秀敏[1] 盛晓棠[1] 崔春生[1] 

机构地区：[1]沈阳军区总医院全军心血管病研究所先心病内科,辽宁沈阳110016

出　　处：《中国介入心脏病学杂志》2016年第1期23-27,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨动脉导管未闭(PDA)介入封堵术后血小板减少的危险因素和早期诊断。方法纳入2011年2月至2015年5月成功行介入封堵术的PDA患者80例,其中男17例(21.2%),年龄0.6~66.0(17.5±17.1)岁。根据封堵术后血小板计数绝对值分组,血小板计数<100×10~9/L为严重血小板减少组(14例),血小板计数≥100×10~9/L为非严重血小板减少组(66例),收集患者缺损直径、封堵器直径、体表面积(BSA)等资料,分析血小板减少的危险因素。结果严重血小板减少组患者封堵器直径[18.0(14.0,30.0)mm比12.0(6.0,18.0)mm,P<0.001]、缺损直径[10.0(6.0,18.0)mm比4.0(2.0,9.0)mm,P<0.001]、封堵器直径/BSA[21.0(8.9,43.7)mm/m^2比10.7(3.2,32.8)mm/m^2,P<0.001]、封堵前肺动脉收缩压[(99.1±21.4)mm Hg比(45.2±16.3)mm Hg,P<0.001]、封堵后肺动脉收缩压[(51.9±15.8)mm Hg比(38.3±18.6)mm Hg,P<0.05]显著大于非严重血小板减少组,差异均有统计学意义。严重血小板减少患者封堵术后第2天全部血小板减少,其减少相对值为7.0%~86.0%(45.0±23.0)%,绝对值为36.0×10~9/L^191.0×10~9/L[(92.0±66.0)×10~9/L],封堵后第3天13例(92.9%)患者封堵术后血小板绝对值减少至100×10~9/L以下,其减少相对值33.0%~93.0%(66.0±20.0)%,绝对值为16.0×10~9/L^147.0×10~9/L[(61.0±39.0)×10~9/L]。logistic回归分析发现封堵术前血小板计数(OR 1.009,95%CI 1.001~1.018,P<0.05)、封堵器直径(OR 1.257,95%CI 1.069~1.478,P<0.01)为血小板减少的危险因素。结论 PDA封堵术后严重血小板减少的危险因素是封堵术前血小板计数和封堵器直径。对封堵器直径超过14 mm的患者,术后第2天复查血液分析,如较术前降低,术后第3天再次复查血液分析,可及时发现严重血小板降低患者,排除低危患者。Objective To investigate the risk factors and early diagnosis of the severe thrombocytopenia complicating transcatheter ccclusion of patent ductus arteriosus（ PDA）. Methods Between February,2011 and May,2015,80 patients with patent ductus arteriosus underwent percutaneous intervention occlusion were studied. Results Average age were（ 17. 5 ± 17. 1） years,63 were females（ 78. 8%）,mean weight were（ 35. 6 ± 20. 2） kg（ from 6. 0 to 75. 0 kg）,mean body surface area（ BSA）were（ 1. 09 ± 0. 44） m^2（ from 0. 32 to 1. 91 m^2）. A bolus of heparin calcium（ 80 U/kg） was administered by intravenous injection. The mean diameters of patent ductus arteriosus were 4 mm（ from 2 to 18 mm）,and the mean diameters of occluders were 12 mm（ from 6 to 30 mm）. 14 patients were found to have severe thrombocytopenia（ PLT count 100 × 10~9/ L）. The reduction rate of platelet in 12 of 14 patients was more than 19%. The diameters of all occluders were equal to or more than 14 mm,the mean diameters of patent ductus arteriosus were 10 mm（ from 6 to 18 mm） and the mean diameters of occluders were 18 mm（ from 14 to 30 mm）. All the 14 patients started to present progressive decrease in PLT count since the second day post procedure. Taking the selected occluder diameter greater than 14 mm as cut-off points in diagnosis of severe thrombocytopenia,the sensitivity was 100 %,specificity was 68 %,the positive predictive value was 40 %,and the negative predictive value was 100 %. Combined with the postprocedural second day complete blood count analysis and the platelet count decreased by 10 % as cut-off points in diagnosis of severe thrombocytopenia patients, the sensitivity was 93 %, specificity was 67 %, the positive predictive value was 65 %, the negative predictive value was 93 %. If taking the platelet count decreased by 7 % on second day as cut-off points in diagnosis of severe thrombocytopenia patients,the sensitivity was 100 %, specificity was 57 %, the positive predictive value was 61 %, th

关 键 词：血小板减少 动脉导管未闭 介入治疗 

分 类 号：R541.1[医药卫生—心血管疾病]