用VSD封堵器治疗婴儿PDA后发生血小板下降4例的临床分析  

Clinical analysis of 4pediatric cases with postoperative thrombocytopenia after patent ductus arteriosus occlusion with muscular VSD occluder

作　　者：王祥[1] 陈智[1] 杨舟[1] 夏元喜[1] 左超[1] 向金星[1] 王勋[1] WANG Xiang;CHENG Zhi;YANG Zhou;XIA Yuanxi;ZUO Chao;XIANG Jingxing;WANG Xun(Children's Hospital of Hunan Province,Hunan,Changsha,410007,China)

机构地区：[1]湖南省儿童医院,长沙410007

出　　处：《临床心血管病杂志》2020年第4期386-389,共4页Journal of Clinical Cardiology

基　　金：湖南省卫生健康委科研计划项目(No:B2019014)。

摘　　要：目的:总结肌部室间隔缺损(VSD)封堵器封堵婴儿动脉导管未闭(PDA)术后,血小板减少的情况并分析其可能发生原因。方法:选取湖南省儿童医院2018-01-2019-04使用肌部VSD封堵器封堵治疗婴幼儿PDA术后发生的血小板下降的4例病例,总结其血小板下降情况、PDA大小、封堵器型号,以及相应的治疗措施等。结果:肌部VSD封堵器封堵婴幼儿巨大PDA血小板下降发生率为57.1%,术后4例患儿血小板均有不同程度下降,开始下降时间为术后3~4d,血小板下降最低值(30~53)×109/L,术后2例患儿予以甲泼尼松龙3~5 mg/kg静脉治疗2~3d,其余2例只予对症处理,4例患儿血小板于术后7~10d恢复正常。1例患儿术后复查超声心动图封堵器周围少许残余分流。术后2例患儿皮肤可见少许出血点,所有患儿无其他部位出血情况。结论:肌部VSD封堵器封堵婴幼儿PDA术后血小板减少的可能性不容忽视,其发生原因考虑封堵器成形以,及阻流片因素造成的血小板机械破坏有关,术后应密切监测血小板以及凝血功能情况。Objective:To summarize the incidence of thrombocytopenia after closure of patent ductus arteriosus(PDA)in infants with muscular ventricular septal defect(VSD)occlude,and analyze its possible causes.Method:The 4cases of thrombocytopenia after PDA interventional treatment with muscular VSD occluder were selected in Hunan Children's Hospital from January 2018to April 2019.The data of thrombocytopenia was detected,including the size of PDA and the type of occluder,as well as the treatments.Result:The incidence of thrombocytopenia was 57.1%in infant with huge PDA treated by VSD occlude.The postoperative platelet declined in the 4cases.The platelet of 4cases were normal after 7~10days.A few bleeding spots could be seen on the skin of 2children after operation,and no obvious bleeding was found in other parts of all children.Conclusion:The thrombocytopenia should not be ignored in infants with PDA treated by muscular VSD occluder.

关 键 词：动脉导管未闭 肌部室间隔缺损封堵器 介入封堵治疗 血小板减少 

分 类 号：R541.3[医药卫生—心血管疾病]