同期行冠状动脉搭桥术合并瓣膜置换术患者平均血小板体积与术后异常引流的相关分析

Relationship between mean platelet volume and postoperative abnormal drainage undergoing coronary artery bypass grafting with valve replacement

目的 :研究同期行冠状动脉搭桥术合并瓣膜置换术患者的平均血小板体积(mean platelet volume,MPV)水平与术后抗凝治疗所致异常引流的关系,为术后抗凝治疗方案提供依据。方法:回顾性分析需同期行冠状动脉搭桥术合并瓣膜置换术患者共72例,收集临床资料,根据术后5 d内总引流量的P75及抗凝相关出血事件将患者分为2组。结果:术前MPV和术前血小板计数呈负相关(r=-0.511,P<0.001),与术后引流量呈正相关(r=0.300,P=0.013)。组2中患者的年龄、饮酒史、生物瓣膜使用率、术后血小板使用量均高于组1,术前MPV水平高于组1,术后血小板计数低于组1(均P<0.05)。年龄、合并饮酒史、术前MPV是患者术后异常引流的独立危险因素。术前MPV水平绘制受试者工作特征曲线(ROC曲线),曲线下面积(AUC)为0.691,(95%CI0.553~0.829,P=0.012),最佳截点10.75 fl,敏感性0.714,特异性0.617。结论 :同期行冠状动脉搭桥术合并瓣膜置换术的患者,术前MPV水平与术后抗凝治疗导致的异常引流具有明显相关性,且具很好的独立预测价值。对于术前MPV大于10.75 fl、高龄、合并饮酒史、置换生物瓣的患者,术后抗凝治疗应该谨慎,并注意凝血功能的监测。

Objective：To investigate the correlation between mean platelet volume（MPV） and abnormal drainage induced by postoperative anticoagulant therapy in patients undergoing coronary artery bypass grafting with valve replacement,to provide evidences for formulating postoperative anticoagulant treatment regimens. Methods：Retrospective analysis was performed on 72 patients received coronary artery bypass grafting with concomitant valve replacement.The patients were divided into 2 groups by P75 of the total drainage volume and the anticoagulation-related bleeding. Results：Preoperative MPV presented a negative correlation with preoperative platelet count（r=-0.511,P〈0.001）,and a positive correlation with postoperative drainage volume（r=0.300,P=0.013）.In Group 2,patient＇s age,proportion of patients with history of alcohol intake,using biovalve and postoperative platelet transfusion volume were all higher than those in Group 1,the preoperative MPVe was higher than that in Group 1,and the postoperative platelet count was lower than that in Group 1（all P〈0.05）.Age,history of alcohol intake,and preoperative MPV were shown to be independent risk factors for postoperative abnormal drainage.When plotting the receiver operating characteristic（ROC） curve for MPV,the area under the curve（AUC） was 0.691（95% CI 0.553 ～0.829,P =0.012）,the optimal cut-off point was 10.75 fl,the sensitivity was 0.714,and the specificity was 0.617.Conclusion：In patients undergoing coronary artery bypass grafting with valve replacement,preoperative MPV presented significant correlation with abnormal drainage induced by postoperative anticoagulant therapy,indicating its good predictive value.For those patients with the preoperative MPV 10.75 fl,older age,history of alcohol intake,and received biovalve replacement, exercise in postoperative anticoagulation should be careful,and attention should be paid to monitoring of coagulation function.