动脉导管未闭介入封堵术后血小板减少的相关因素分析

Retrospective analysis of patients with thrombocytopenia after patent ductus arteriosus interventional occlusion

目的 探讨动脉导管未闭（PDA）患者介入封堵术后血小板减少的相关危险因素。方法回顾性分析350例接受PDA封堵治疗患者的临床资料，其中14例患者术后出现血小板减少症。记录患者的年龄、性别、体质量、PDA直径、封堵器直径、平均肺动脉压力、术中肝素用量、封堵器厂家和术后有无残余分流，并分析封堵术后血小板减少的独立危险因素。对患者术后血小板数量减少的程度进行分级，分析不同分级患者血小板计数恢复正常的时间。结果多因素logistic回归分析显示，封堵器直径（OR=2．238，P〈0．05）、术中肝素用量（OR：1．912，P〈0．05）、术后有无残余分流（OR=3．247，P〈0．01）是PDA封堵术后血小板减少的危险因素。对轻度血小板减少的患者不予临床干预，其血小板恢复时间为（7±2）d；对中度血小板减少的患者给予糖皮质激素治疗后，血小板恢复正常时间为（12±4）d；对重度血小板减少的患者输注血小板后，血小板恢复正常的时间为（21±7）d。结论封堵器直径、术中肝素用量、术后有无残余分流可能是导致PDA封堵术后血小板减少的危险因素。根据术后血小板减少程度的不同，通过临床观察及治疗，患者的血小板计数在不同时间内可恢复正常。

Objective To explore the risk factors of patent ductus arteriosus （PDA） patients with thrombocytopenia after PDA interventional occlusion. Methods Thrombocytopenia occurred in 14 out of 350 patients underwent PDA occlusion. Age, gender, body weight, PDA size, occluder size, mean pulmonary arterial pressure, the dose of heparin, the manufacturer of occlnder, residual shunt after operation were analyzed. The recovery time of different grades of thrombocytopenia was observed. Results Multivariate logistic regression showed that the PDA size （ OR = 2. 238, P 〈 0. 05 ）, the dose of heparin （ OR = 3. 247,P 〈 0. 05 ） , residual shunt after operation （ OR = 1.912, P 〈 0. 01 ） were the independent risk factors of thromhocytopenia after PDA occlusion. The recovery time of mild thrombocytopenia was （ 7 ± 2 ） days without treatment. The recovery time of moderate thrombocytopenia was （12± 4 ） days with glucocortieoids treatment. The recovery time of severe thrombocytopenia was （21 ± 7 ） days with platelet transfusion. Conclusions The oeeluder size, dose of heparin, residual shunt are the independent risk factors of thromboeytopenia after PDA interventional occlusion. Recover time of thrombocytopenia after PDA interventional occlusion is closely related to the severity of thrombocytopenia.