小年龄低体重先天性心脏病体外循环术后肝素治疗与凝血功能的关系  

Relationship between heparin dosing and coagulation tests after cardiopulmonary bypass in young infants with congenital heart disease and low birth weight

作　　者：马鞅 刘海燕 李青 秦珍珍 马新平[2] 刘彩霞[2] Ma Yang;Liu Haiyan;Li Qing;Qin Zhenzhen;Ma Xinping;Liu Caixia(Department of Pediatrics,Shanxi Medical University,Taiyuan 030001,China;Department of Cardiothoracic Surgery,Shanxi Children's Hospital,Taiyuan 030025,China)

机构地区：[1]山西医科大学儿科医学系,太原030001 [2]山西省儿童医院心胸外科,太原030025

出　　处：《中华小儿外科杂志》2023年第12期1081-1086,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨心肺转流术(cardiopulmonary bypass,CPB)术后早期肝素抗凝治疗对小年龄低体重先天性心脏病(congenital heart disease,CHD)凝血功能指标D-二聚体的影响。方法回顾性分析山西省儿童医院心胸外科2019年12月至2021年12月因CHD行CPB辅助下心内直视手术治疗的102例患儿资料,其中男57例,女45例。按术后是否泵入肝素治疗分为观察组(5 U·kg^(-1)·h^(-1)小剂量肝素治疗)与对照组(未使用肝素),观察组54例,年龄为(119.81±66.90)d,体重为(5.4±1.1)kg;对照组48例,年龄为(138.00±67.67)d,体重为(5.65±1.31)kg。检测两组患儿术前、术后(术毕入监护室)、用药前(术后次日用肝素前)、用药后(用肝素后24 h)的凝血功能,观察两组凝血功能指标D-二聚体的变化趋势以及两组间的差异。对计数资料采用Pearsonχ^(2)检验,对计量资料采用t检验或Wilcoxon两样本秩和检验。结果两组患儿性别、年龄、体重等差异均无统计学意义(P>0.05)。观察组与对照组术前、术后、用药前的D-二聚体差异均无统计学意义(均P>0.05);用药后观察组D-二聚体较对照组明显降低,差异有统计学意义(Z=-2.21,P=0.027);用药后与用药前D-二聚体的变化量比较,两组间差异有统计学意义(Z=-2.17,P=0.030)。观察组术后较术前以及术后至用药前D-二聚体持续升高,差异有统计学意义(P<0.05);用药后与用药前相比差异无统计学意义(Z=-0.33,P=0.740);用药后与术后相比差异有统计学意义(Z=-3.41,P=0.001);用药后与术前相比D-二聚体差异有统计学意义(Z=-3.06,P=0.002),仍高于术前。对照组从术前至用药后D-二聚体持续升高,各时段相互比较D-二聚体差异均有统计学意义(均P<0.05)。结论CHD患儿CPB术后早期使用小剂量肝素抗凝治疗,可缓解CPB引发的凝血功能异常,有利于预防术后血栓和弥散性血管内凝血。Objective To explore the effect of early heparin anticoagulation on D-dimer of blood coagulation parameters in young and low-birth-weight congenital heart disease(CHD)after cardiopulmonary bypass(CPB).Methods From December 2019 to December 2021,the relevant clinical data were retrospectively reviewed for 102 children undergoing CPB-assisted open-heart surgery for CHD at Shanxi Children's Hospital.There were 57 boys and 45 girls.Based upon an injection of heparin or not,they were assigned into two groups of observation(5 U·kg^(-1)·h^(-1) low-dose heparin dosing)and control(non-heparin dosing).Fifty-four children in observation group were(119.81±66.90)day in age and(5.4±1.1)kg in weight.And 48 children in control group were(138.00±67.67)day in age and(5.65±1.31)kg in weight.Coagulation functions of two groups were detected preoperatively,postoperatively(admission into CCU),before medication(before heparin on the next day post-operation)and after medication(24h after heparin dosing).The change trends of D-dimer of coagulation function and the difference were observed between two groups.Pearsonχ^(2) test was utilized for counting data and t-test or Wilcoxon two-sample rank sum test for measurement data.Results No significant inter-group differences existed in gender,age or weight(P>0.05).No significant inter-group differences in D-dimer distribution pre/postoperatively or before medication(P>0.05);After medication,D-dimer was significantly lower in observation group than that in control group and the difference was statistically significant(Z=-2.21,P=0.027).The inter-group change of D-dimer after and before medication was statistically significant(Z=-2.17,P=0.030).In observation group,D-dimer level continued rising pre/postoperatively and before medication and the difference was statistically significant(P<0.05);No significant difference existed between before and after medication(Z=-0.33,P=0.740).The difference was statistically significant after medication and post-operation(Z=-3.41,P=0.001).The difference o

关 键 词：心脏病 先天畸形 心肺转流术 抗凝治疗 D-二聚体 

分 类 号：R726.5[医药卫生—儿科]