先天性心脏病介入封堵术后血小板急剧减少与机体器官出血的原因分析  

The Cause of Rapid Thrombocytopenia and Organ Hemorrhage in Congenital Heart Disease Patients After Interventional Occlusion

作　　者：杨婷[1] 田野[2] 刘晓桥[2] 王记培 刘会[2] 罗依然[2] 

机构地区：[1]遵义医学院附属贵航三00医院护理部,贵州省贵阳市550006 [2]贵州省人民医院心内科

出　　处：《中国循环杂志》2016年第10期993-996,共4页Chinese Circulation Journal

基　　金：贵州省社会发展公关项目(黔科合SY字[2013]3018号)

摘　　要：目的:探索先天性心脏病(先心病)介入封堵术后患者血小板急剧减少与机体器官出血的原因。方法:先心病介入封堵术患者共665例,其中房间隔缺损(ASD)患者100例(ASD组)、室间隔缺损(VSD)患者100例(VSD组),动脉导管未闭(PDA)患者465例(PDA组)。对比介入封堵术前后血小板数量变化,及PDA封堵器直径与血小板计数相关性。随机测量部分患者封堵器伞盘两端压力差,包括ASD组50例,VSD组50例,PDA组102例,并根据PDA直径大小将PDA组分为巨大PDA患者42例和中小PDA患者60例,对比封堵器伞盘两端导管压力差。结果:ASD组和VSD组患者无血小板重度降低及机体器官出血事件,PDA组患者发生血小板计数重度降低36例(7.74%,36/465),机体器官出血18例(3.87%,18/465),且仅发生在巨大PDA患者中。PDA组PDA封堵器直径与术后血小板计数呈负相关性(r=-0.659,P=0.001)。封堵术前后封堵器伞盘两端压力差比较:术后即刻与术前比,PDA组收缩期、舒张期压差及平均压差均升高(P均<0.05);收缩期压差VSD组(56.57±15.33)mm Hg(1mm Hg=0.133 k Pa),中小PDA患者(58.33±26.65)mm Hg,巨大PDA患者(94.66±27.62)mm Hg,巨大PDA患者较VSD及中小PDA患者均显著升高(P均<0.01)。结论:先心病介入封堵术后发生血小板急剧减少与机体器官出血仅见于巨大PDA患者。封堵器两端的高压力差形成滤过封堵器的高速血流对血小板的冲刷性损伤是术后血小板急剧减少的主要原因。Objective：To study the cause of rapid thrombocytopenia and organ hemorrhage in congenital heart disease（CHD） patients after interventional occlusion.Methods：A total of 665 CHD patients received interventional occlusion in our hospital from 2011-01 to 2015-12 were enrolled.The patients were divided into 3 groups according to the defects：Atrial septal defect（ASD） group,n=100,Ventricular septal defect（VSD） group,n=100 and Patent ductus arteriosus（PDA） group,n=465.Pre-and post-interventional occlusion platelet levels,the relationship between PDA occluder diameter and platelet counts were compared.Pressure difference between both sides of occluder was randomly measured in a part of patients including 50 in ASD group,50 in VSD group and 102 in PDA group.Based on occluder diameter,the 102 PDA patients were further divided into 2 subgroups：Giant PDA,n=42 and Medium-small PDA,n=60;pressure differences between both sides of occluder were compared between 2 subgroups.Results：No severe thrombocytopenia and organ hemorrhage occurred in ASD group or VSD group.PDA group had 36/465（7.74%） patients with severe thrombocytopenia,18（3.87%） with organ hemorrhage and all of them occurred in giant PDA subgroup;the diameter of PDA occluder was negatively related to post-operative to platelet counts（r=-0.659,P=0.001）.For pressure difference on both sides of occluder,compared with prior operation,PDA group showed increased systolic and diastolic pressure differencesand increased mean pressure difference at immediately post operation,all P 0.05;systolic pressure difference in VSD group was（56.57±15.33） mm Hg,in Medium-small PDA subgroup was（58.33±26.65） mm Hg and in Giant PDA subgroup was（94.66±27.62） mm Hg which was much higher than those in VSD group and Medium-small PDA subgroup,all P〈0.01.Conclusion：Rapid thrombocytopenia and organ hemorrhage in CHD after interventional occlusion only happened in giant PDA patients.High pressure difference formed high-speed filtration blood flow

关 键 词：心脏缺损 先天性 介入封堵术 血小板减少 

分 类 号：R54[医药卫生—心血管疾病]