射频消融术围术期儿童血浆D-二聚体检测的意义

Clinical Value of Perioperative Plasma D-Dimer in Pediatric Radiofrequency Ablation

目的探讨儿科射频导管消融术(RFCA)对凝血状态的影响,观察D-二聚体在RFCA围术期血浆水平变化及其临床意义。方法选择2003年12月-2005年12月本院行RFCA的快速心律失常患儿30例。男12例,女18例;年龄7～13岁。分别在插管前、电生理标测后、RFCA成功即刻、术后2、7d采集血样本1.8mL,3000r/min,离心10min,获得上层血浆低温保存,用ELISA检测其血浆D-二聚体水平。采用SPSS12.0软件对资料行配对t检验。结果D-二聚体在RFCA成功即刻水平最高,术后7d基本恢复到插管前水平。对本组进行的成组资料配对比较中发现,D-二聚体除插管前与术后7d及电生理标测后与术后2d无显著差异外,其他各组比较均有统计学意义(Pa<0.01)。结论儿科RFCA具有术中、术后高凝状态的病理基础,而D-二聚体的水平变化的检测有利于对RFCA引起的血栓栓塞事件进行及时预报,以指导抗凝药物的应用和避免临床不良事件的发生。

Objective To explore the effects of radiofrequency catheter ablation （RFCA） on the blood coaguable states and the clinical value of perioperative plasma D - dimer. Methods The plasma level of D - dimer was assayed by enzyme - linked immunosorbent assay （ELISA） in blood samples of 30 children who were undertaken RFCA. Blood samples were consecutively obtained before cannulating, after electrophysiologic （EP） study ,immediately after RFCA, the second day and the seventh day after RFCA. The centrifuged spead was 3 000 r/ min, keep it for 10 minutes to obtain the upper plasma, and the crvopreserve. Results The plasma levels of D - dimer was highest at the time point when RFCA was successfully accomplished and restored to preoperative level in the seventh day after RFCA. There were statistically significant difference in the paried values at different time points （Pa 〈0. 01 ）, except for the paired values that before cannulating and at the seventh day after RFCA,as well as the values that after EP and at the second day after RFCA. Conclusions Pediatric RFCA has the same pat- hological basis for the hypercoagulable state in the perioperative period. The assay of the D - dimer is beneficial in the prediction of thromboembolic events,in order to guide the administration of anticoagulation and avoid pediatric clinical adverse events.