急性A型主动脉夹层患者围术期血小板动态变化与预后相关性分析  

The correlation of perioperative platelet count and prognosis in acute type A aortic dissection

作　　者：金祺[1] 李呈龙[1] 樊凡[2] 刘楠[1] JIN Qi;LI Chenglong;LIU Nan;FAN Fan(Department of Cardiovascular Centre of Intensive Care,Beijing Anzhen Hos-pital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科危重症监护中心,100029 [2]陕西省第二人民医院检验科

出　　处：《心肺血管病杂志》2020年第2期173-177,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家卫生和计划生育委员会—公益性行业科研专项项目(201402009);北京市科技重大专项课题(Z171100001017083);国家科技支撑计划项目(2015BAI12B03)。

摘　　要：目的:本研究通过回顾性分析急性A型主动脉夹层围术期,血小板水平与死亡率及并发症的相关性。方法:选取首都医科大学附属北京安贞医院,2016年12月至2017年12月,于我院诊断为急性A型主动脉夹层并急诊行手术治疗的患者共211例,收集术前病史资料及术中、术后诊疗资料,术后每日晨6:00抽取全血行血常规检查,收集PLT数据,住院期间并发症、住院生存情况及ICU住院时间。结果:患者围术期血小板水平整体呈下降趋势。术后血小板水平(PLTmin)与住院死亡呈负相关(OR=0.976,95%CI:0.957~0.995,P=0.016),与术后并发症增多风险呈负相关(OR=0.966,95%CI:0.948~0.985,P<0.001),与ICU住院时间延长呈负相关(OR=0.984,95%CI:0.977~0.991,P<0.001)。结论:术后血小板水平越低,术后患者住院死亡率越高,ICU住院时间越长,术后并发症发生可能越多,术后血小板计数每增加1×109/L,住院死亡率约可降低2.4%,ICU住院时间延长风险约降低1.6%,术后并发症增多的风险约降低3.4%。同时,术后血小板水平与手术时间及术中失血量密切相关。Objective:Acute aortic dissection is one of the common intensive diseases in cardiology department in recent years,with high mortality and rapid development.There are studies that indicate the correlation of preoperative platelet count and in-hospital mortality,which illustrated that acute type a aortic dissection(TAAD)patients with a preoperative platelet count lower than 119×109/L would have a higher in-hospital mortality.In this study,we retrospectively analyze the correlation of Perioperative Platelet Count and Prognosis in Acute Type A Aortic Dissection.Methods:211 patients with TAAD undergone emergency operation in Capital Medical University affiliated Beijing Anzhen Hospital from December 2016 to December 2017 was included in our study.Perioperative patient data was collected,including operation method,perioperative platelet count,coagulation test,postoperative mortality,ICU stay and complication.Results:Patients with TAAD undergone acute surgery tend to have a decrease in platelet count.Postoperative level of Platelet Count has a negative correlation with in-hospital mortality(OR=0.976,95%CI:0.957-0.995,P=0.016),complication increase(OR=0.966,95%CI:0.948-0.985,P<0.001)and prolonged ICU stay(OR=0.984,95%CI:0.977-0.991,P<0.001).Conclusions:Patients with a lower postoperative platelet count will have a higher incidence of in-hospital mortality,prolonged ICU stay and complication increase.With every unit increase of Platelet Count,in-hospital mortality decrease 2.4%,ICU stay decrease 1.6%and complication risk decrease 3.4%.Postoperative platelet count is strongly associated with operation time and blood loss during operation.

关 键 词：急性A型主动脉夹层 围术期血小板水平 输血相关性肺损伤 急性肾损伤 

分 类 号：R54[医药卫生—心血管疾病]