[1]张坡,朱鲜阳,张端珍,等.先天性心脏病介入封堵术后血小板减少及影响因素[J].介入放射学杂志,2016,(06):483-486.
　ZHANG Po,ZHU Xian-yang,ZHANG Duan-zhen,et al.Thrombocytopenia occurring after percutaneous transcatheter closure of congenital heart defects and its related factors [J].journal interventional radiology,2016,(06):483-486.
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先天性心脏病介入封堵术后血小板减少及影响因素 ()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
期数:
2016年06期
页码:
483-486
栏目:
心脏介入
出版日期:
2016-06-25

文章信息/Info

Title:
Thrombocytopenia occurring after percutaneous transcatheter closure of congenital heart defects and its related factors
作者:
张坡; 朱鲜阳; 张端珍; 王琦光; 韩秀敏; 盛晓棠; 崔春生
Author(s):
ZHANG Po;  ZHU Xian-yang;  ZHANG Duan-zhen;  WANG Qi-guang;  HAN Xiu-min;  SHENG Xiao-tang;  CUI Chun-sheng
Department of Congenital Heart Diseases, Cardiovascular Research Institute of PLA, General Hospital of Shenyang Military Area Command, Shenyang, Liaoning Province 110016, China
关键词:
 ; 【关键词】血小板减少;  动脉导管未闭;  室间隔缺损;  房间隔缺损;  介入封堵治疗
文献标志码:
A
摘要:
【摘要】目的探讨常见先天性心脏病介入封堵术后血小板减少发生率及影响因素。 方法2011年2月至2015年5月采用经皮介入封堵术治疗204例先天性心脏病患者,术前及术后2 d作常规血液检查,了解血小板计数变化。 结果204例患者中女146例(71.6%),男58例(28.4%),平均年龄(18.2±16.8)岁；动脉导管未闭(PDA)80例(39.2%),室间隔缺损(VSD)72例(35.3%),房间隔缺损(ASD)52例(25.5%)。介入封堵术后血小板计数减少率为(8.69±21.86)%(-91.6%~85.8%)；7例(3.4%)血小板计数减少至(50~100)×109/L,2例(1.0%)＜50×109/L；49例(24.0%)血小板计数下降≤10%,84例(41.2%)下降10%~50%,8例(3.9%)下降＞50%。术后血小板计数为(226±79)×109/L,较术前(250±73)×109/L明显降低(P＜0.01)；PDA、ASD术后血小板计数均较术前降低(P＜0.01),VSD术后虽较术前降低,但未达到统计学差异(P=0.131)。Logistic回归分析发现PDA术后血小板减少的独立危险因素是封堵术前血小板计数(OR=1.009,95%CI 1.001~1.08,P=0.036)和封堵器直径(OR=1.257,95%CI 1.069~1.478,P=0.006)。 结论血小板减少是先天性心脏病介入封堵术后短期内常见并发症,PDA封堵器直径≥14 mm和ASD封堵器直径＞20 mm较易发生血小板减少。

参考文献/References:

［1］中国医师协会儿科医师分会先天性心脏病专家委员会, 中华医学会儿科学分会心血管学组, 《中华儿科杂志》编辑委员会. 儿童常见先天性心脏病介入治疗专家共识［J］. 中华儿科杂志, 2015, 53： 17-24.

［2］廖祁伟, 张伟华, 光雪峰, 等. 动脉导管未闭介入封堵术后血小板减少的相关因素分析［J］. 中华心血管病杂志, 2013, 41： 229-232.

［3］田野, 刘晓桥, 张萍, 等. 动脉导管未闭介入封堵术后血小板急剧减少三例［J］. 中华心血管病杂志, 2012, 40： 340-341.

［4］Smolka G, Pysz P, Jasinski M, et al. Multiplug paravalvular leak closure using Amplatzer Vascular Plugs Ⅲ: a prospective registry［J］. Catheter Cardiovasc Interv, 2016, 87： 478-487.

［5］中国医师协会心血管内科分会先心病工作委员会. 常见先天性心脏病介入治疗中国专家共识——三、动脉导管未闭的介入治疗［J］. 介入放射学杂志, 2011, 20： 172-176.

［6］Karaelik M, Oztürk P, Doyurgan O, et al. A complication following the transcatheter closure of a muscular ventricular septal defect［J］. J Tehran Heart Cent, 2015, 10: 149-151.

［7］Stone PA, Campbell JE, Aburahma AF. Femoral pseudoaneurysms after percutaneous access［J］. J Vasc Surg, 2014, 60: 1359-1366.

［8］Dubner S, Hadid C, Azocar D, et al. Radiofrequency catheter ablation of frequent premature ventricular contractions using ARRAY multi-electrode balloon catheter［J］. Cardiol J, 2016, 23： 17-22.

［9］Bovet J, De Maistre E, Bejot Y, et al. Are myeloproliferative neoplasms a risk factor for heparin-induced thrombocytopenia?［J］. Br J Haematol, 2015 ［Epub ahead of print］

［10］Bito S, Miyata S, Migita K, et al. Mechanical prophylaxis is a heparin-independent risk for anti-platelet factor 4/heparin antibody formation after orthopedic surgery［J］. Blood, 2016, 127： 1036-1043.

［11］Arepally GM, Ortel TL. Clinical practice. Heparin-induced thrombocytopenia［J］. N Engl J Med, 2006, 355: 809-817.

［12］Warkentin TE, Greinacher A. Heparin-induced thrombocytopenia: recognition, treatment, and prevention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy［J］. Chest, 2004, 126(3 Suppl):311S-337S.

［13］Warkentin TE, Roberts RS, Hirsh J, et al. An improved definition of immune heparin-induced thrombocytopenia in postoperative orthopedic patients［J］. Arch Intern Med, 2003, 163: 2518-2524.

［14］Warkentin TE, Sheppard JA, Horsewood P, et al. Impact of the patient population on the risk for heparin-induced thrombocytopenia［J］. Blood, 2000, 96: 1703-1708.

［15］Warkentin TE, Greinacher A. Heparin-induced thrombocytopenia and cardiac surgery［J］. Ann Thorac Surg, 2003, 76: 2121-2131.

［16］Girolami B, Prandoni P, Stefani PM, et al. The incidence of heparin-induced thrombocytopenia in hospitalized medical patients treated with subcutaneous unfractionated heparin: a prospective cohort study［J］. Blood, 2003, 101: 2955-2959.

［17］Zhang P, Zhu XY. Severe thrombocytopenia complicating transcatheter occlusion of a patent ductus arteriosus［J］. J Invasive Cardiol, 2013, 25: E88-E92.

 

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备注/Memo

备注/Memo:
(收稿日期： 2015-11-20)


(本文编辑： 边佶)
更新日期/Last Update: 2016-06-21