先天性心脏病小儿Fontan手术围术期血小板因子4的变化及其临床意义

Changes of perioperative platelet factor 4 in children with congenital heart disease receiving Fontan operation

目的探讨先天性心脏病小儿Fontan手术围术期血小板因子(PF4)变化的临床意义。方法选择行Fontan手术(F组)和室间隔缺损修补术(V组)的先天性心脏病患儿各30例,美国麻醉医师学会分级Ⅱ～Ⅲ级,年龄1～13岁,体重7～51kg。分别于开胸手术前及术后第1天采集患儿的股静脉血,测定血浆中PF4的含量。结果 F组术前及术后第1天的PF4水平均显著高于V组同时间(P值均<0.01),两组术后第1天的PF4水平与同组术前的差异均无统计学意义(P值均>0.05)。结论 Fontan手术围术期患儿的PF4水平升高,可增加诱发肝素-PF4抗体形成及肝素诱导的血小板减少症的风险,是Fontan术后血栓形成的危险因素。

Objective To investigate the perioperative platelet factor 4（PF4） changes in children with congenital heart disease receiving Fontan operation.Methods Sixty patients aged from 1 to 13 years old,weighing from 7 to 51 kg,American Society of Anesthesiologists（ASA） grade Ⅱ-Ⅲ,were enrolled in this study.Patients in group F were scheduled for Fontan operation and others in group V received ventricular septal defect repair（n=30 each）.Femoral venous blood samples were collected to detect plasma PF4 levels before surgery（T1） and day 1 postoperatively（T2）.Results PF4 levels in group F were significantly higher than those in group V at T1 and T2（P0.01）,while the difference of PF4 levels at T1 and T2 had no statistical significance in all the patients（P0.05）.Conclusion Perioperative increase of PF4 levels in the children receiving Fontan operation can increase the risk of heparin-PF4 antibody formation and heparin-induced thrombocytopenia,and it is a risk factor of thrombosis after Fontan operation.