房间隔缺损封堵术后低分子肝素应用时间对血小板的影响

Effects of Low Molecular Weight Heparin Application Time on Platelets in Atrial Septal Defect Patients after Percutaneous Closure Surgery

目的观察房间隔缺损(ASD)封堵术后低分子肝素应用时间对血小板的影响。方法 61例ASD患者根据术后低分子肝素应用时间分为3 d组(依诺肝素100 U/kg,每12 h 1次皮下注射,应用3 d,46例)和1 d组(依诺肝素100 U/kg,12 h一次皮下注射,应用24 h,15例)。封堵术前、术后第1天(T1)、术后第3天(T3)清晨抽空腹外周静脉血,检测血小板(PLT)、平均血小板压积(MPCT)、平均血小板体积(MPV)、血小板分布宽度(PDW)。结果房间隔缺损封堵术后,血小板由术前(227.41±66.67)×109/L降至T(1195.26±47.07)×109/L(P<0.01)、T(3179.00±47.30)×109/L(P<0.01);MPCT由术前0.22±0.05降至T10.20±0.05(P<0.01)、T3 0.18±0.04(P<0.01);MPV由术前(9.94±0.90)fL升至T(310.31±0.79)fL(P<0.05);PDW由术前(11.01±1.61)10(GSD)升至T(311.69±1.65)10(GSD)(P<0.05)。血小板T1～T3间下降程度3 d组(6±12)%,1 d组(14±9)%(P<0.01);血小板术后3 d总下降程度3 d组(19±13)%,1 d组(27±9)%(P<0.01);MPCT术后3 d总下降程度3 d组(17±11)%,1 d组(21±10)%(P<0.05)。结论房间隔缺损封堵术后,血小板活化状态持续3 d以上,延长依诺肝素应用时间可以减少血小板消耗。

Objective To investigate the effects of low molecular weight heparin application time on platelet in patients of atrial septal de- fect （ASD） after pereutaneous closure. Methods A total of 61 cases atrial septal defect patients received percutaneous closure were recruit- ed for the study and divided into 3 days group （Enoxaparine 100 U/kg,hypodermic injection,interval 12 h,3 days,46 cases） and 1 day group （Enoxaparine 100 U/kg,hypodermic injection,interval 12 h,1 day,15 cases）. Platelet （PLT）,mean plateletcrit （MPCT）,mean platelet volume （MPV）, platelet distribution width （PDW） before closure, and 1 st day （T1）, 3rd day （T3） after closure were measured. Re- sult After pereutaneous closure,platelet was decreased from preoperation （227.41±66.67）×10^9/L to T1 （195.26±47.07）×10^9/L （P 〈 0.01 ）,T3 （ 179.00±47.30）×10^9/L （P 〈 0.01 ）, MPCT was decreased from preoperation 0.22±0.05 to T1 0.20±0.05 （P 〈 0.01 ） ,T3 0.18±0.04 （P 〈 0.01 ）. MPV was increased from preoperation （9.94±0.90） fL to T3 （10.31±0.79） fL （P 〈 0.05）. PDW was increased from pre- operation （11.01±1.61） 10（GSD） to T3 （11.69±1.65） 10（GSD） （P 〈 0.05）. The reduction rate of platelet between the T1 and T3 was （6±12）% in 3 days group,and （14±9）% in 1 day group （P〈 0.01）. Platelet was reduced （19±13）% in 3 days group, （27±9）% in 1 day group during 3 days after operation （P 〈 0.01 ）. MPCT was reduced （ 17±11 ）% in 3 days group, （21±10）% in 1 day group during 3 days after operation （P 〈 0.05 ）. Conclusion After pereutaneous closure of atrial septal defect, platelet activation state lasts more than 3 days, thus extending the application time of Enoxaparine can reduce the platelet consumption.