动脉导管未闭介入封堵术后严重血小板减少的治疗效果分析

Therapeutic effect of severe thrombocytopenia in patients underwent transcatheter patent ductus arteriosus occlusion

目的 探讨动脉导管未闭介入封堵术后血小板减少的治疗效果.方法 回顾性分析2011年2月至2014年11月在沈阳军区总医院接受介入封堵术治疗的80例单纯动脉导管未闭患者的临床资料.介入封堵术中应用普通肝素80 U/kg.患者在术前和术后监测血常规,若术后血小板计数减少≥5％,且血小板计数＜ 100×10^9/L（严重血小板减少）,则给予治疗（包括卧床、制动、应用硝普钠控制血压、应用激素和人免疫球蛋白抑制免疫反应）.术后随访至2015年5月.结果 （1）介入封堵术后第2天,54例（67.5％）患者出现血小板减少,其中41患者的血小板减少≥5％,35例患者的封堵器直径≥14 mm.严重血小板减少患者共14例,封堵器直径均≥14 mm.封堵器直径＜14 mm或血小板减少＜5％的患者均未发生严重血小板减少.（2）共14例血小板减少患者接受治疗,住院和随访期间患者均未发生出血事件.血小板计数在术后4.5（3.8,6.0）d达最低值,最低值为16.5（7.5,37.3）×10^9/L.血小板计数恢复至≥30×10^9/L的时间为8.0（4.8,9.5）d,恢复至≥100×10^9/L的时间为12.0（9.8,39.3）d.住院时间为15.5（11.8,21.5）d.接受治疗患者术后随访3.8（1.0,4.9）年,随访结束时患者的血小板计数均在正常范围.结论 动脉导管未闭介入封堵术后血小板减少患者在严密监护下及时治疗的长期效果良好.

Objective To investigate the therapeutic effect of severe thrombocytopenia in patients underwent transcatheter patent ductus arteriosus occlusion.Methods Clinical data of 80 pure patent ductus arteriosus patients who underwent interventional occlusion between February 2011 and November 2014 in General Hospital of Shenyang Military Region were retrospective analyzed.A bolus of heparin calcium （80 U/kg） was administered by intravenous injection during the procedure.Blood test was conducted in all patients before and after the procedure.The patients with both platelet reduction rate ≥ 5% and platelet count 〈 100 ×10^9/L（severe thrombocytopenia） were treated by following strategies：bed rest,avoidance of activities,intensive control of blood pressure through sodium nitroprusside administration,and inhibition of presumed immunological reaction by glucocorticoids and human immunoglobulin administration.Follow-up ended in May 2015.Results （1） A total of 54 cases （67.5%） were diagnosed as thrombocytopenia in second days after the procedure.The reduction rate of platelet in 41 out of 54 patients was equal or more than 5% on the second day,and the diameter of occludes were equal or more than 14 mm in 35 out of these 54 patients.Severe thrombocytopenia occurred in 14 patients and the occluder diameter was ≥ 14 mm in these 14 patients.Severe thrombocytopenia did not occur in patients with occlude diameter 〈 14 mm or with reduction rate of platelet 〈5%.（2） A total of 14 severe thrombocytopenia patients were treated.No bleeding events occurred in hospital and during the whole follow-up period.The the lowest value of platelet count of patients was seen on the 4.5 （3.8,6.0） days post the procedure.The lowest numbers were 16.5 （7.5,37.3） ×10^9/L.The platelet count of patients restored to more than 30 ×10^9/L on the 8.0 （4.8,9.5） days and restore to more than 100 ×10^9/L on the 12.0 （9.8,39.3） days post procedure.The average hospitalization day of the patients were 15.5 （11.8,21.5） days.The platelet counts of severe thrombocytopenia patients were normal during the end of follow up （median 3.8 （1.0,4.9）years）.Conclusion The patients with very severe thrombocytopenia after transcatheter occlusion of patent ductus arteriosus are associated with a benign outcome in case of timely and proper treatment.