小儿动脉导管未闭介入封堵术后严重血小板减少临床分析  

Severe thrombocytopenia after transcatheter closure of patent ductus arteriosus in children:analysis of 11 cases

作　　者：程真莉[1] 李谧[1] 吕铁伟[1] 向平[1] 白永虹[1] 计晓娟[1] 刘云黎[1] 蒲晓芳[1] 易岂建[1] 

机构地区：[1]重庆医科大学附属儿童医院心血管内科儿童发育疾病研究省部共建教育部重点实验室儿科学重庆市重点实验室重庆市儿童发育重大疾病诊治与预防国际科技合作基地,重庆400014

出　　处：《第三军医大学学报》2017年第14期1486-1492,共7页Journal of Third Military Medical University

基　　金：重庆市卫生局医学科研计划项目(重点项目)[2011-1-065]~~

摘　　要：目的探讨动脉导管未闭(patent ductus arteriosus,PDA)介入封堵术后严重血小板减少的原因。方法收集重庆医科大学附属儿童医院2006年1月至2016年11月PDA介入封堵术后发生严重血小板减少的病例,分析严重血小板减少发生的高危因素、诊治措施及预后。结果共收集介入封堵PDA患儿848例,其中发生严重血小板减少11例,发生率为1.29%。11例患儿年龄(1.4±0.5)岁,包括男性3例,女性8例。降主动脉造影测PDA直径为(7.9±3.0)mm,选择封堵器前伞直径8~18(11.6±2.5)mm,术后1 d复查心脏超声发现7例患儿有不同程度残余分流。患儿术前血小板为(261.0±74.9)×10~9/L,术后血小板最低下降至(23.4±9.3)×10~9/L。8例发生于术后第1~3天,2例发生于术后第4天,1例发生于术后第6天;8例出现皮肤出血点,3例合并鼻衄,1例合并溶血,6例合并中度贫血(Hb:71~86 g/L),所有病例无重要脏器出血。8例术后1~3 d出现发热,1例合并穿刺处巨大血肿。除1例21-三体综合征患儿合并室间隔缺损封堵术后出现顽固性血小板减少和溶血,内科治疗3周无效转外科手术后血小板恢复外,其余经止血、输注血小板、激素、丙种球蛋白等内科治疗后,9例于术后2周内血小板恢复正常,1例于术后第8周恢复正常。结论 PDA介入封堵术后严重血小板减少的发生可能与PDA直径较大、封堵器直径较大、残余分流、术后感染、穿刺处血肿有关,经正规内科保守治疗,预后良好。Objective To explore the causes of thrombocytopenia following transcatheter closure of patent ductus arteriosus（ PDA） in children. Methods The clinical data were collected from children who experienced thrombocytopenia following transcatheter closure of PDA in our hospital between January 2006 and November 2016. Results Among the total of 848 children undergoing transcatheter device closure of PDA in our hospital,11（ 3 boys and 8 girls） developed severe thrombocytopenia after the procedure with an incidence of 1. 29%. The mean age of the 11 children was 1. 4 ± 0. 5 years,and the mean diameter of PDA was 7. 9 ±3. 0 mm as measured by cardiac catheterization; the mean size of the occluder used was 11. 6 ± 2. 5 mm（ range 8-18 mm）. Residual shunts were found on the first day after the operation in 7 cases. The mean platelet count of the 11 children was（ 261. 0 ± 74. 9） × 10^9/L before the operation,and was lowered to（ 23. 36 ± 9. 26） × 10^9/L after the operation. Thrombocytopenia occurred within 3 d after the operation in 8cases,on the 4th day in 2 cases,and on the 6th day in 1 case. The clinical manifestations included hemorrhagic skin rashes（ 8 cases） and nasal hemorrhage（ 3 cases）,but none of the children had hemorrhage in the vital organs. One child had hemolysis,and 6 children showed moderate anemia（ Hb of 71-86 g/L）.Eight children experienced fever within 3 d after transcatheter closure,and one child had a huge puncture hematoma in the right inguinal fold. Nine children fully recovered after treatment with medications within2 weeks and one child recovered within 8 weeks. One child with Down syndrome combined with PDA and ventricular septal defect treated by interventional therapy had refractory hemolysis and thrombocytopenia after the operation. The patient failed to respond to a 3-week medication therapy and was subsequently transferred for surgery to remove the occluders,after which the platelet count recovered the normal level. Conclusion The possible causes of thrombocy

关 键 词：动脉导管未闭 介入封堵术 血小板减少 小儿 

分 类 号：R619[医药卫生—外科学] R725.411[医药卫生—临床医学]