急性心力衰竭应用主动脉内球囊反搏患者血小板减少因素分析

Cause analysis of thrombocytopenia in acute heart failure implanted with intra-aortic balloon pump

目的探讨急性心力衰竭应用主动脉内球囊反搏（IABP）患者血小板减少的原因。方法回顾性选取首都医科大学附属北京安贞医院2011年11月至2013年11月收治的应用IABP的急性心力衰竭患者50例，记录应用IABP的时间以及应用后患者的血小板变化情况；分析血小板减少和疾病类型、球囊大小、性别的关系以及血小板减少对患者住院时病死率的影响。结果应用IABP的时间为32．4～1136．5h，平均（181±34）h。应用IABP后，27例出现血小板减少（15例为轻度、9例为中度、3例为重度），血小板最低计数出现的平均时间为（100±lO）h。急性心肌梗死引发的急性心力衰竭患者血小板减少发生率与其他因素引发的急性心力衰竭比较[51．6％（16／31）比57．9％（11／19）]，差异无统计学意义（P〉0．05）。应用34CC球囊患者血小板减少发生率明显低于应用40CC球囊患者[31．3％（5／16）比64．7％（22／34）]，男性血小板减少发生率明显低于女性[46．2％（18／39）比81．8％（9／11）]，差异均有统计学意义（均P〈0．05）。50例应用1ABP患者中，17例住院时死亡。出现血小板减少的患者病死率明显高于血小板未减少患者[48．1％（13／27）比17．4％（4／23）]，差异有统计学意义（P〈0．05）。结论急性心力衰竭应用IABP患者血小板减少与球囊大小、性别等因素有关，血小板减少会增加患者的病死率。

Objective To explore the causes of thrombocytopenia in acute heart failure （AHF） implanted with intra-aortic balloon pump （IABP）. Methods Totally 50 cases with AHF implanted with IABP from November 2011 to November 2013 were retrospective enrolled. The time duration of IABP implantion and change of thrombocyte were recorded; the correlations of thrombocytopenia with disease type, size of ballon, gender were analyzed, the influence of thrombocytopenia on hospital mortality rate were assessed. Results The time duration of IABP implantion was （ 181 ± 34 ） h （ 32. 4-1 136. 5 h ）. There was 27 patients with thrombocytopenia （ mild ： 15 cases, moderate： 9 cases, severe： 3 cases）, the time of the least platelet count was（100 ± 10） h. The incidence of throm- bocytopenia in patients with acute myocardial infarction induced AHF was not significantly different from that in patients with other causes induced AHF [ 51.6% （ 16/31 ） vs 57.9% （ 11/19 ） ] （ P 〉0. 05 ）. The incidence of thrombocytopenia was significantly lower in patients applied with 30 CC balloon than that in patients applied with 40 CC balloon [31.3% （5/16） vs 64. 7% （22/34） ], was significantly lower in males than that in femals [46. 2% （18/39） vs 81.8% （9/11）] （P 〈 0. 05）. In 50 patients, 17 cases was dead in hospital; the mortality rate in patients with thrombocytopenia was significantly higher than that in patients without thrombocytopenia [ 48. 1% （13/27） vs 17.4% （4/23）1 （P 〈0. 05）. Conclusion Thrombocytopenia can increase the morality rate in acute heart failure patients implanted with IABP, which is correlated with the size of implanted balloon and gender.