血栓弹力图评估小儿先天性心脏病术后凝血异常现况  

Analysis of Thromboelastograph-guided Postoperative Coagulopathy for Children undergoing Congenital Heart Surgery

作　　者：李丹[1] 郑林[1] 李霞[1] 鲁中原[1] 王旭[1] LI Dan ZHENG Lin LI Xia LU Zhong-Yuan WANG Xu(Fuwai Hospital, National Center for Cardiovascular Disease, Chines Academy of Medical Science and Peking Union Medical college, Beijing, 100037, China.)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院小儿重症监护室,北京100037

出　　处：《中国分子心脏病学杂志》2017年第4期2153-2155,共3页Molecular Cardiology of China

基　　金：中央级公益性科研院所基金2016-F01

摘　　要：目的应用血栓弹力图TEG评价小儿先天性心脏病术后凝血异常发生的流行病现况。方法依据先心病有无左向右或双向分流且血氧饱和度≤90%,将661例患儿分为紫绀组和非紫绀组,并按照年龄<1岁,1-3岁和≥3岁进行亚组分析。术后常规进行TEG检测比较主要参数之间的差异。结果先心病患儿术后凝血异常发生率高达46.3%,其中,血小板功能低下发生率43.7%占主要原因,其他凝血异常发生率如纤维蛋白原缺乏13%和凝血因子缺乏4.2%。与非紫绀组相比,紫绀患者术后凝血异常发生率63.4%显著高于非紫绀组39.7%,且凝血因子缺乏和纤维蛋白原缺乏均有显著差异,P<0.05。年龄亚组分析显示,<1岁患儿凝血异常风险相对于其他年龄组患儿增加,但紫绀患儿在1-3岁时纤维蛋白原功能和血小板功能低下发生率反而更高。结论先心病患儿心脏术后凝血异常发生率较高,其中血小板功能低下是主要原因。低龄和紫绀可能是术后凝血异常的高危风险因素,其次较大紫绀儿童的凝血风险也会相应增加。Objective To analyze the incidence rate of postoperative coagulopathy for pediatric patients with congenital heart disease（CHD） by thromboelastograph（TEG）. Methods 661 pediatric patients after cardiac surgery with CPB were divided into two groups by the type of CHD and oxygen saturation, cyanotic group（n=198）and acyanotic group（n=463） and put in subgroups based on age.All of them received TEG measurement postoperatively. TEG results were then recorded and compared between two groups. Results There were 306 patients（46.3%）postoperatively with the abnormal TEG results mainly because of platelet dysfunction（43.7%）,other including low fibrinogen（13%） and low clotting factors（4.2%）.For cyanotic group,it＇s significant higher compared to acyanotic group,63.4% and 39.7%, respectively. The rate of low clotting factors and fibrinogen were both high in cyanotic group than those acynotic group, P〈0.01, while the platelet dysfunction rate was similar between two groups, P〈0.05.The subgroup analyses found that patients younger than 1 year old,the incidence of postoperative coagulopathy with abnormal TEG results was higher than other patients.However, low fibrinogen and platelet dysfunction are more often in cyanotic patients under 1 to 3 years old. Conclusion According to TEG monitoring, pediatric patients after cardiac surgery are more likely to suffer from coagulopathy, mainly because of platelet dysfunction. Younger children and cyanosis may also be some of the high risk factors contributing to postoperative coagulopathy.Older cyanotic children is also the high risk population.

关 键 词：血栓弹力图 先天性心脏病 凝血异常 

分 类 号：R726.5[医药卫生—儿科]