儿童镶嵌手术(经胸微创小切口封堵术)后阿司匹林抗血小板聚集的实验研究

Experimental Research on the Aspirin Inhibit Platelet Aggregation after Infant's Hybrid Procedure

目的本研究旨在探讨儿童镶嵌手术后服用阿司匹林抑制血小板聚集的不同从而对口服阿司匹林的量提出更加合理的方案,同期监测C反应蛋白在围手术期的变化,探讨C反应蛋白(C-reacive protein,CRP)在儿童镶嵌手术围手术期对阿司匹林抗血小板聚集的程度是否有指示意义。方法选取经镶嵌手术成功行房间隔缺损、室间隔缺损、动脉导管未闭封堵术的患儿共24例,将其随机分为A、B两组,A组于术后每日给予3mg/(kg·d)的阿司匹林,B组于术后每日给予5mg/(kg·d)的阿司匹林,分别于术前1天、手术结束2h内、术后第4天抽取静脉血测定花生四烯酸(AA)诱导的血小板的聚集率和二磷酸腺苷(ADP)诱导的血小板的聚集率。所有入选病例均于术前、术后第2天、术后第6天测定C反应蛋白。结果 A、B两组患儿术后当天血小板的聚集程度较术前均明显增加(P<0.01),第4天时A、B两组患儿血小板聚集程度较术后结束当天均明显下降(P<0.01)。A、B两组分别在口服阿司匹林3mg/kg与5mg/kg后第4天测定的血小板聚集程度差异无统计学意义(P>0.05),C反应蛋白与阿司匹林抗血小板聚集程度相关性分析无明显统计学意义(P>0.05)。结论镶嵌手术后口服阿司匹林3mg/kg与5mg/kg抗血小板聚集程度无明显差异,C反应蛋白在儿童镶嵌手术围手术期对阿司匹林抗血小板聚集的程度无指示意义。

Objective To analyze the difference of platelet aggregation（one group take aspirin 3mg/kg and the other take aspirin 5mg/kg everyday） after Infant＇s hybrid procedure in order to find the optimal dose in infant.Furthermore,C reaction protein was measured in order to find whether can it indicate the change of platelet aggregation after taking aspirin.Metbods Twenty-four patients who underwent successful hybrid procedure （minimally invasive incision throw thorax）were chosen to two groups of which one accepted aspirin 3mg/（kg · d） and the other accepted aspirin 5mg/（kg · d）.The platelets aggregation rate before,instantly,and four days after the operation induced by AA and ADP were measured.Also,the CRP before,two days after the operation and six days after the operation were measured.Results There was significant increase in the platelets aggregation rate of all the groups instantly after the operation （P ＜ 0.01）.There was significant decrease in the platelets aggregation rate of all the groups four days after the operation.There was no significant difference in the platelets aggregation rate between the A 、B groups four days after the operation.（P ＞ 0.05）.There was no significant relation between the platelets aggregation rate and the value of CRP.Conclusion The platelet aggregation could be inhibited equal effectually by 3mg/kg and 5mg/kg in infant who underwent hybrid procedure.The value of CRP cannot tell the difference of aspirin inhibiting platelet aggregation.