儿童肝移植术后肝素诱导的血小板减少症临床分析  

Clinical analysis of heparin induced thrombocytopenia after liver transplantation in children

作　　者：熊强[1,2,3] 张明满[1,2,3] 李英存 蒲从伦[1,2,3] 郭春宝 康权[1,2,3] 邓玉华 陈柏林[1,2,3] 

机构地区：[1]重庆医科大学附属儿童医院肝胆外科,儿童发育疾病研究教育部重点实验室 [2]儿童发育重大疾病国家国际科技合作基地 [3]儿科学重庆市重点实验室,400014

出　　处：《中华肝胆外科杂志》2016年第10期651-654,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：国家临床重点专科建设项目（国卫办医函[2013]544）;重庆市科委课题（estc2014yykfA110014）

摘　　要：目的分析儿童肝植术后肝素诱导的血小板减少症（HIT）的临床特点及其对儿童肝移植预后的影响。方法回顾性分析2006年6月至2015年3月重庆医科大学附属儿童医院64例肝移植患儿的临床资料。根据患儿HIT发生情况，分析其发病因素，以及对肝移植预后的影响。结果64例肝移植患儿，使用普通肝素抗凝组41例，其中5例（5／41，12．1％）发生HIT，≤3岁2例（2／33，6．1％），〉3岁3例（3／8，37．5％）；低分子肝素组23例无HIT发生。围手术期死亡HIT组3例（3／5，60．0％），其中2例合并肝动脉血栓；非HIT组死亡6例（8／59，13．6％）。结论儿童肝移植术后HIT是导致患儿肝移植死亡的原因之一，年龄较大的患儿发生率较高。Objective To analyze the clinical features and the impact of heparin induced thrombo- cytopenia （HIT） after liver transplantation in children. Methods The clinical data of 64 patients who un- derwent liver transplantation from June 2006 to March 2015 in the Childreng Hospital of Chongqing Medical University were retrospectively analyzed. The aims were to investigate the risks of HIT, and its impact on prognosis of liver transplantation. Results 64 patients were enrolled in this study. Five patients （ 5/41, 12.1% ） progressed to develop HIT postoperatively in the unfraetionated heparin （UFH） group. This group included 2 patients who were aged under 3 years （2/33, 6.1% ） and 3 patients who were aged over 3 years （3/8, 37.5% ）. No patient progressed to develop HIT in the low molecular weight heparin （LMWH） group. For the perioperative mortality, 3 patients （3/5, 60% ） died in the HIT group including 2 patients had hepatic artery thrombosis. Six patients （ 8/59, 13.6% ） died in the Non-HIT group. Conclusions HIT was one of the death causes after liver transplantation in children. Children aged over 3 years had a higher incidence of HIT.

关 键 词：儿童 肝移植 肝素 血小板减少症 

分 类 号：R726.5[医药卫生—儿科]