成人心脏外科术后血小板减少情况及临床意义  

Status and clinical significance of thrombocytopenia after cardiac surgery in adults

作　　者：刘子娜[1] 常硕[1] 刘娜[2] 刘平[1] 孙寒松[1] LIU Zina;CHANG Shuo;LIU Na;LIU Ping;SUN Hansong(Department of Adult Cardiac Surgery,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Science,Peking Union Medical College,Beijing,100037,P.R.China;Department of Blood Transfusion,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Science,Peking Union Medical College,Beijing,100037,P.R.China)

机构地区：[1]中国医学科学院北京协和医学院阜外医院成人外科中心,北京100037 [2]中国医学科学院北京协和医学院阜外医院输血科,北京100037

出　　处：《中国胸心血管外科临床杂志》2022年第3期350-355,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的观察成人心脏外科术后患者血小板减少情况,探索其发生机制及临床意义。方法回顾性分析2020年5—6月阜外医院外科重症监护室(intensive care unit,ICU)二区接收的240例各类心脏外科手术患者的临床资料,其中男137例、女103例,平均年龄(56.0±12.0)岁。根据术后血小板情况,将患者分为血小板减少组和非血小板减少组。比较两组患者临床基线资料、术前血小板计数、术后血小板计数最低值、术后引流量、血制品输注情况、呼吸机使用时间、 ICU停留时间、住院时间及并发症。结果术前血小板平均计数199×10^(9)/L±55×10^(9)/L,术后血小板平均计数最低值109×10^(9)/L±37×10^(9)/L,平均降低比例44.1%±15.8%。术后235例(97.9%)患者血小板计数较术前降低,血小板计数<100×10^(9)/L患者98例(40.8%),血小板计数<75×10^(9)/L患者46例(19.2%),血小板计数<50×10^(9)/L患者8例(3.3%)。多因素logistic回归分析结果显示体外循环时间>120 min[OR=2.576,95%CI(1.313,5.053),P<0.05]为术后血小板减少的独立危险因素。对比血小板减少组(<100×10^(9)/L)和非血小板减少组(>100×10^(9)/L),术后引流量[685(510,930)mL vs. 560(440,790)mL,P<0.05]、呼吸机使用时间[(25.5±16.8)h vs.(17.3±8.5)h,P<0.05]、ICU停留时间[(85.2±54.7)h vs.(60.0±33.9)h,P<0.05]以及住院时间[(15.8±6.2)d vs.(14.2±3.9)d,P<0.05]差异均有统计学意义。多因素logistic回归分析结果显示血小板减少[OR=2.993,95%CI(1.622,5.524),P<0.05]为术后ICU停留时间>72 h的独立危险因素。血小板减少组术后并发症发生率高于非血小板减少组(10.2%vs. 2.1%,P<0.05)。结论成人心脏外科术后血小板减少发生率较高,不同类型手术发生率不同,体外循环可能是导致血小板减少的因素,血小板减少与患者术后延迟恢复相关。Objective To observe the status of thrombocytopenia in adult patients after cardiac surgery, and to explore its mechanism and clinical significance. Methods Retrospective analysis of 240 patients after cardiac surgery in the 2 nd ward of surgical intensive care unit(ICU) of Fuwai Hospital from May to June 2020 was conducted, including 137 males and 103 females with a mean age of 56.0±12.0 years. According to postoperative platelet status, the patients were divided into a thrombocytopenia group and a non-thrombocytopenia group. The clinical baseline data, preoperative platelet count, postoperative minimum platelet count, volume of drainage, transfusion of blood products, mechanical ventilator time, ICU stay, hospital stay and complications were compared between the two groups. Results The mean preoperative platelet count was 199×10^(9)/L±55×10^(9)/L and the mean postoperative platelet nadir was 109×10^(9)/L±37×10^(9)/L,with a mean reduction rate of 44.1%±15.8%. The platelet count of 235(97.9%) patients after operation was lower than that before operation. Among them, 98(40.8%) patients had platelet count<100×10^(9)/L, 46(19.2%)<75×10^(9)/L and 8(3.3%)<50×10^(9)/L.Results of multivariable logistic analysis showed that cardiopulmonary bypass time>120 min(OR=2.576, 95%CI 1.313-5.053, P<0.05) was an independent risk factor for postoperative thrombocytopenia. Mechanical ventilator time(25.5±16.8 h vs. 17.3±8.5 h, P<0.05), ICU stay(85.2±54.7 h vs. 60.0±33.9 h, P<0.05) and hospital stay(15.8±6.2 d vs. 14.2±3.9 d,P<0.05) were longer in the thrombocytopenia group(<100×10^(9)/L) compared with the non-thrombocytopenia group(>100×10^(9)/L). More drainage volume [685(510, 930) mL vs. 560(440, 790) mL, P<0.05] and complications occurred in the thrombocytopenia group. In multivariable analysis, thrombocytopenia was significantly inversely associated with prolonged ICU stay(OR=2.993, 95%CI 1.622-5.524, P<0.05). Conclusion Thrombocytopenia occurs commonly after adult cardiac surgery, and the incidence in differe

关 键 词：心脏外科 血小板减少 术后恢复 

分 类 号：R654.2[医药卫生—外科学]