先天性心脏病介入封堵术后血小板减少及影响因素  

Thrombocytopenia occurring after percutaneous transcatheter closure of congenital heart defects and its related factors

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,110016

出　　处：《介入放射学杂志》2016年第6期483-486,共4页Journal of Interventional Radiology

摘　　要：【摘要】目的探讨常见先天性心脏病介入封堵术后血小板减少发生率及影响因素。 方法2011年2月至2015年5月采用经皮介入封堵术治疗204例先天性心脏病患者,术前及术后2 d作常规血液检查,了解血小板计数变化。 结果204例患者中女146例（71.6%）,男58例（28.4%）,平均年龄（18.2±16.8）岁；动脉导管未闭（PDA）80例（39.2%）,室间隔缺损（VSD）72例（35.3%）,房间隔缺损（ASD）52例（25.5%）。介入封堵术后血小板计数减少率为（8.69±21.86）%（-91.6%~85.8%）；7例（3.4%）血小板计数减少至（50~100）×109/L,2例（1.0%）＜50×109/L；49例（24.0%）血小板计数下降≤10%,84例（41.2%）下降10%~50%,8例（3.9%）下降＞50%。术后血小板计数为（226±79）×109/L,较术前（250±73）×109/L明显降低（P＜0.01）；PDA、ASD术后血小板计数均较术前降低（P＜0.01）,VSD术后虽较术前降低,但未达到统计学差异（P=0.131）。Logistic回归分析发现PDA术后血小板减少的独立危险因素是封堵术前血小板计数（OR=1.009,95%CI 1.001~1.08,P=0.036）和封堵器直径（OR=1.257,95%CI 1.069~1.478,P=0.006）。 结论血小板减少是先天性心脏病介入封堵术后短期内常见并发症,PDA封堵器直径≥14 mm和ASD封堵器直径＞20 mm较易发生血小板减少。Objective To investigate the incidence of thrombocytopenia occurring after percutaneous transcatheter occlusion of congenital heart defects, including patent dutus arteriosus （PDA） , ventricular septal defect （VSD） and atrial septal defect （ASD） , and to discuss its related factors. Methods A total of 204 patients with congenital heart disease, who received percutaneous transcatheter occlusion treatment during the period from February 2011 to May 2015, were enrolled in this study. Routine blood tests were performed before and 2 days after the treatment to observe the changes of platelet count. Results The 204 patients included 146 females （ 71.6% ） and 58 males （ 28.4% ） , with a mean age of （ 18.2 ±16.8 ） years old. Pathologically, PDA was diagnosed in 80 patients （39.2%）, VSD in 72 patients （35.3%） and ASD in 52 patients （25.5%）. The postoperative reduction rate of platelet count was （ 8.69 ±21.86） %, ranging from- 91.6% to 85.8%. In 7 patients （3.4%） the platelet count reduced to 50-100× 10^9/L, in 2 patients （1.0%） the platelet count reduced to〈50× 109/L, in 49 patients （24.0%） the reduction of platelet count was ≤10%, and in 84 patients （41.2%） the reduction of platelet count was 10%-50%, and in 8 patients （3.9%） the reduction of platelet count was〉50%. Postoperative platelet count was （226±79）× 109/L, which was statistically significant lower than the preoperative platelet count of （250±73）× 109/L （P〈0.01）. In patients with PDA or ASD, the postoperative platelet counts were significantly decreased when compared with the preoperative data （P〈0.01）. In patients with VSD, the postoperative platelet counts were lower than preoperative ones, but the differences were not statistically significant （P=0.131）. Logistic regression analysis showed that the independent risk factors related to postoperative thrombocytopenia in patients with PDA were the preoperative platelet count （ OR= 1.009, 95%CI： 1.001-1.018, P=0.03

关 键 词：血小板减少 动脉导管未闭 室间隔缺损 房间隔缺损 介入封堵治疗 

分 类 号：R541.1[医药卫生—心血管疾病]