急性A型主动脉夹层术后早期血小板减少的危险因素分析  

Early thrombocytopenia after acute type A aortic dissection Risk factor analysis

作　　者：吴淑敏[1] 王明伟 曹向波 史博伦 李艳凤[1] 张峰[1] 于洋涛 王晖[1] 赵霞飞 原阳阳 何发明 WU Shumin;WANG Mingwei;CAO Xiangbo;SHI Bolun;LI Yanfeng;ZHANG Feng;YU Yangtao;WANG Hui;ZHAO Xiafei;YUAN Yangyang;HE Faming(CSICU of Grand Vascular Center,Henan Chest Hospital,Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学附属河南省胸科医院心脏大血管中心CSICU,450000

出　　处：《心肺血管病杂志》2025年第2期174-178,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：河南省医学科技攻关计划省部共建项目(2018010036);国家临床重点专科建设项目(国卫办医政函[2023]213号)。

摘　　要：目的:探讨急性Stanford A型主动脉夹层(acute type A aortic dissection,ATAAD)术后早期血小板减少的危险因素。方法:选取2020年10月至2022年10月,于郑州大学附属河南省胸科医院收治并行手术治疗的ATAAD患者214例作为研究对象,根据术后第1天血小板数量分为血小板减少症组(PLT<100×10^(9)/L,92例)和非血小板减少症组(PLT≥100×10~9/L,122例),比较两组患者术前临床特征、术中资料的差异,分析ATAAD患者影响术后血小板降低的危险因素。结果:与非血小板减少组相比,血小板减少组术前中性粒细胞、体外循环应用时间、升主动脉阻断时间、手术时间、术后24 h引流量均显著升高,术前心率、收缩压、舒张压显著降低,差异均具有统计学意义(均P<0.05)。Logistic多因素回归分析显示,术中升主动脉阻断时间延长(OR=1.022,P<0.05)是ATAAD术后早期血小板降低的独立危险因素。结论:术前低血小板血症、术中主动脉阻断时间长、术后24小时引流多对ATAAD术后早期血小板降低具有较高的预测价值,临床可据此制定有效干预措施以改善患者治疗效果。Objective:To explore the risk factors for early thrombocytopenia after acute type A aortic dissection(ATAAD)surgery.Methods:Collect clinical data of 214 ATAAD patients who underwent surgical treatment in our hospital from October 2020 to October 2022,They were divided into a thrombocytopenia group(PLT<100×109/L,92 cases)and a non thrombocytopenia group(PLT≥100×10^(9)/L,122 cases)based on the platelet count on the first day after surgery.The differences in preoperative clinical characteristics and intraoperative data between the two groups were compared,and the risk factors affecting postoperative thrombocytopenia in ATAAD patients were analyzed.Results:Compared with the non thrombocytopenia group,the thrombocytopenia group showed a significant increase in preoperative neutrophils,extracorporeal circulation duration,ascending aortic occlusion time,surgica duration,and postoperative 24-hour drainage volume.Preoperative heart rate,systolic blood pressure,and diastolic blood pressure were significantly reduced,and thedifferences were statistically significant(all P<0.05).Logistic multiple regression analysis showed that prolonged ascending aortic occlusion time during surgery(OR=1.022,P<0.05)was an independent risk factor for early thrombocytopenia after ATAAD surgery.Conclusions:Preoperative thrombocytopenia,long intraoperative aorticocclusion time,and 24-hour postoperative drainage have high predictive value for early thrombocytopenia after ATAAD surgery.Clinical interventions can be developed based on this to improve patient treatment outcomes.

关 键 词：急性Stanford A型主动脉夹层 血小板减少症 危险因素 

分 类 号：R54[医药卫生—心血管疾病]