儿童肝移植术后早期血小板减少症的危险因素分析  

Analysis of risk factors for thrombocytopenia in early period after pediatric liver transplantation

作　　者：王雪 孙雁[1] 康一生 徐如彬[2] 徐敏 高思楠[1] 高伟[1] 刘懿禾[1] 王兵[1] Wang Xue;Sun Yan;Kang Yisheng;Xu Rubin;Xu Min;Gao Sinan;Gao Wei;Liu Yihe;Wang Bing(Department of Organ Transplantation Center,Tianjin First Central Hospital,Tianjin 300192,China;Department of Anesthesiology,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院器官移植中心,天津300192 [2]天津市第一中心医院麻醉科,天津300192

出　　处：《中华器官移植杂志》2023年第4期209-213,共5页Chinese Journal of Organ Transplantation

基　　金：天津市医学重点学科(专科)建设项目;省部共建组分中药国家重点实验室开放课题(CBCM2022105);天津市第一中心医院春风课题(2020CF05)。

摘　　要：目的探讨儿童肝移植术后2周内发生血小板减少症(thrombocytopenia,TCP)的危险因素及对预后的影响。方法回顾性分析2021年1月至2021年11月于天津市第一中心医院行肝移植手术并符合纳入标准的不满4周岁的162例儿童受者的临床资料。根据术后2周血小板计数最低值是否<100×10^(9)/L,将受者分为TCP组(90例)和非TCP组(72例),分析比较两组儿童受者术前一般情况、手术情况、术后并发症、术后常用抗生素种类及抗凝剂应用、预后等情况,采用单因素和多因素分析儿童肝移植受者术后发生TCP的独立危险因素。应用受试者工作特征(receiver operating characteristic,ROC)曲线分析独立危险因素诊断TCP的临界值,并评估该疾病对儿童受者预后的影响。结果162例儿童受者中有90例(55.56%)术后2周内发生TCP,25例(15.43%)术后当天发生TCP。术前血小板计数中位数为178×10^(9)/L,术后3(1,4)d达到最低值,为65×10^(9)/L;术后6(4,7.25)d受者血小板计数恢复至正常范围。单因素分析结果显示TCP组和非TCP组手术时间[(574.43±80.53)min比(526.75±72.42)min]、术中失血量[400(300,550)ml比320(300,400)ml]、输注红细胞量[2(2,3)U比2(1.5,2.0)U]、术前血小板计数[178.5(141.75,242.5)×10^(9)/L比257(209.75,357.00)×10^(9)/L]、术后感染发生率[27.8%(25/90)比13.9%(10/72)]、哌拉西林钠他唑巴坦钠应用率[8.9%(8/90)比25.0%(18/72)]比较,差异均有统计学意义(P值均<0.05)。多因素Logistic回归分析结果示手术时间(P=0.008)、输注红细胞量(P=0.01)、术前血小板计数(P<0.01)、术后感染率(P=0.02)是TCP发生的独立危险因素。ROC曲线分析结果示手术时间、输注红细胞量、术前血小板计数的最佳临界值分别为535 min、2.75 U和183.5×10^(9)/L。TCP组ICU住院时间4(3,5)d较非TCP组3(3,4)d长,差异有统计学意义(P=0.006)。结论4岁以下肝移植儿童受者术中输注红细胞量大于2.75 U、手术时间大于535 min、术前�Objective To explore the risk factors for the occurrence of thrombocytopenia(TCP)within 2 weeks after pediatric liver transplantation(LT)and examine the relationship between the occurrence of TCP and prognosis.Methods From January 2021 to November 2021,clinical data were retrospectively reviewed for 162 pediatric LT recipients aged under 4 years at Organ Transplantation Center of Tianjin First Central Hospital.Based upon the lowest value of platelet count at Week 2 post-operation,they were assigned into two groups of TCP(n=90)and non-TCP(n=72).General preoperative profiles,intraoperative findings,postoperative complications,types of commonly used antibiotics,anticoagulant dosing and prognosis of two groups were compared.Univariate and multivariate analyses were utilized for examining the independent risk factors for TCP.Receiver operating characteristic(ROC)curve was plotted for examining the cut-off value of independent risk factors for diagnosing TCP.Results Among them,90(55.56%)developed TCP within 2 weeks post-operation and 25(15.43%)developed TCP at Day 1 post-operation.The median preoperative platelet count was 178×109/L and the lowest value was 65×109/L at Day 3(1-4)post-operation with a declining rate of 63.5%and platelet count of recipient normalized at Day 6(4-7.25)post-operation.The results of univariate analysis showed statistically significant inter-group differences in operative duration[(574.43±80.53)min vs.(526.75±72.42)min],intraoperative blood loss[400(300,550)ml vs.320(300,400)ml],red blood cell transfusion[2(2,3)U vs.2(1.5,2.0)U],preoperative platelet count[178.5(141.75,242.5)×109/L vs.257(209.75,357)×109/L],postoperative infection rate[27.8%(25/90)vs.13.9%(10/72)]and dosing rates of piperacillin sodium and tazobactam sodium[8.9%(8/90)vs.25.0%(18/72)](P<0.05).Multivariate Logistic regression analysis revealed statistically significant inter-group differences in operative duration(P=0.008),red blood cell transfusion(P=0.01),preoperative platelet count(P<0.01)and postoperative infection ra

关 键 词：儿童 肝移植 血小板减少症 

分 类 号：R726.5[医药卫生—儿科]