心脏手术围术期应用IABP后血小板减少的临床研究  

Clinical study of thrombocytopenia after implanting IABP in patients undergoing cardiac surgery

作　　者：姜兆磊[1] 尹航[1] 汤敏[1] 马南[1] 沈赛娥[2] 梅举[1] JIANG Zhao-lei;YIN Hang;TANG Min(Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200092, Chin)

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,上海市200092 [2]上海交通大学医学院附属新华医院麻醉科,上海市200092

出　　处：《中国心血管病研究》2018年第5期449-452,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨接受心脏手术的患者围术期应用主动脉内球囊反搏（IABP）后的血小板变化规律及预后.方法 选取2010年1月至2015年6月,上海交通大学医学院附属新华医院心胸外科的心脏手术患者在围术期应用IABP超过3天者共176例,回顾性分析患者的临床资料,记录患者应用IABP前的最后一次血小板计数、应用IABP后每日血小板计数,观察患者有无出血倾向,分析血小板减少与并发症及预后的关系.结果 所有入组患者中共有104例（59.1％）应用IABP后出现血小板减少,其中Ⅰ度减少22例、Ⅱ度减少51例、Ⅲ度减少23例、Ⅳ度减少8例.全组共有17例患者接受血小板输注治疗,无1例出现大出血等严重并发症.全部患者中149例存活并顺利康复出院,27例死亡或自动出院.存活患者中141例患者在出院时血小板计数即恢复正常值,其余8例患者仍为Ⅰ～Ⅱ度血小板减少.结论 血小板减少是应用IABP的并发症之一;但只要加强监护、及时处理,即使出现Ⅲ度、Ⅳ度血小板减少的患者同样可以获得良好的预后.同时,血小板减少并不引起大出血等严重并发症,也可能并非IABP患者住院期间死亡的独立危险因素.Objective To explore the change of platelets after implanting IABP in patients with cardiac surgery and the influence on prognosis.Methods Retrospectively analyze the clinical data of 176 IABP（≥3days） patients from January 2010 to June 2015 in the department of cardiothoracic surgery,Shanghai Jiaotong University School of Medicine.Observe the change of platelets before and after implanting IABP.Analyze the relationship between the thrombocytopenia and patients＇ prognosis.Results The platelets declined after the application of IABP in 104 patients.Twenty two cases were in the first degree of thrombocytopenia;51 cases were in the second degree of thrombocytopenia;23 cases were in the third degree of thrombocytopenia;and 8 cases were in the fourth degree of thrombocytopenia.A total of 17 patients received platelet transfusion,but no patients occurred serious complications relate to bleeding.At discharge,149 patients survived and recovered,and other 27 patients died or were discharged automatically.Of all alive patients,the platelets returned to normal value at discharge in 141 patients,and other 8 patients still had the first or second degree of thrombocytopenia.Conclusion Thrombocytopenia is one of the complications of using IABP.As long as giving intensive care and timely treatment,patients could get a good prognosis,even if there is a third or fourth degree of thrombocytopenia.At the same time,thrombocytopenia may not be an independent risk factor for in-hospital mortality in patients with IABP,because thrombocytopenia does not cause serious complications relate to bleeding.

关 键 词：血小板减少 主动脉内球囊反搏 心脏手术 预后 

分 类 号：R654.2[医药卫生—外科学]