缺血性脑卒中使用脂肪乳后发生血小板减少的临床分析

Clinical analysis of thrombocytopenia after intravenous lipid emulsions in patients with ischemic stroke

目的研究缺血性脑卒中患者使用中长链脂肪乳后血小板减少的发生率和危险因素。方法回顾性分析北京世纪坛医院神经内科2006年1月—2012年12月使用中长链脂肪乳治疗的356例缺血性脑卒中患者,根据治疗后是否发生血小板减少,将患者分为血小板减少组和非血小板减少组,比较两组基线和临床特征。结果缺血性脑卒中患者使用脂肪乳后血小板减少的发生率为6.7%(24/356),单因素分析显示老年、肥胖、基线血小板<200×109·L-1、脂肪乳使用时间>6 d、脂肪乳剂量500 mL·d-1、合用大剂量抗血小板药(阿司匹林200 mg·d-1)和基线高胆固醇可能与发生血小板减少相关(P<0.05)。多因素Logistic回归分析显示高龄、基线血小板<200×109·L-1、脂肪乳使用时间>6 d和合用大剂量抗血小板药可能是血小板减少的独立危险因素。结论高龄、基线血小板<200×109·L-1和合用抗血小板药的缺血性脑卒中患者长时间使用脂肪乳易于发生血小板减少,临床上应被视为发生血小板减少的高危群体。

AIM To evaluate the rate of thrombocytopenia after intravenous medium and long chain lipid emulsions and the risk factors in patients with ischemic stroke. METHODS From January 2006 to December 2012, 356 patients with ischemic stroke undergoing intravenous lipid emulsions in Beijing Shijitan Hospital were reviewed retrospectively. Patients were divided into the thrombocytopenia group and the nonthrombocytopenia group according to the platelet count after intravenous lipid emulsion administration, baseline and clinical characteristics of two groups were compared. RESULTS The rate of thrombocytopenia after intravenous lipid emulsions administration was 6.7% （24/356）. Advanced age, obesity, baseline platelet count 〈 200 x 109. L-l, the duration of lipid emulsions administration 〉 6 days, total dose of lipid emulsions 500 mL＂ d-1 and combined aspirin 200 mg ·d^-1 and baseline high cholesterol were significantly associated with lipid emulsionsinduced thrombocytopenia （P 〈 0.05）. In a logistic regression model, advanced age, baseline platelet 〈 200 × 10^9·L^-1, the duration of lipid emulsions administration 〉 6 days and combined aspirin 200 mg ·d^-1 remained probably as independent predictors of thrombocytopenia. CONCLUSION Advanced age, low baseline platelet count （〈 200 × 10^9·L^-1）, longer duration of lipid emulsions administration and combined large dose antiplatelet drugs in patients with ischemic stroke is prone to thrombocytopenia. These patients should be considered highrisk groups of thrombocytopenia after intravenous lipid emulsions.