心脏瓣膜置换术后血小板减少的发生规律和影响

Occurrence regularity of thrombocytopenia and its outcomes after cardiac valve replacement

目的:探索心脏瓣膜置换术后血小板减少的发生规律和影响。方法:连续完成初次瓣膜置换手术256例,其中二尖瓣或主动脉瓣单瓣膜置换213例,二尖瓣和主动脉瓣双瓣膜置换43例;风湿性病变145例,非风湿性病变111例。术前血小板计数均≥100×109/L,术后第1周反复复查血小板计数,记录体外循环时间、主动脉阻断时间、呼吸机辅助时间和重症监护室滞留时间。术后3个月随访血小板计数。结果:(1)术后1周内发生血小板减少(<100×109/L)113例,发生率43.7%,体外循环时间、呼吸机辅助时间和ICU滞留时间较非血小板减少者延长;(2)生物瓣单瓣膜置换35例,血小板减少28例,发生率80%,机械瓣单瓣膜置换178例,发生62例,比率34.8%,两组比较,P=0.000;(3)双机械瓣膜置换的血小板减少发生率53.5%,与单机械瓣组比较,差异有统计学意义(P=0.019);(4)风湿性病变组血小板减少发生率54.5%,非风湿性病变组发生率30.6%,差异有统计学意义(P=0.000);(5)血小板减少组死亡2例,非血小板减少组无死亡,差异无统计学意义(P=0.194);(6)术后3~6个月共随访到252例患者,占应随访的99.2%,均未见血小板减少。结论:体外循环时间延长、使用生物瓣、双瓣膜置换、风湿性病变易发生血小板减少,血小板减少者的呼吸机辅助时间和重症监护室滞留时间更长。

Objective： To analyze the occurrence regularity of thrombocytopenia and its outcomes after cardiac valve replacement. Methods： 256 cases of first cardiac valve replacement were completed continuously, including 213 cases of single cardiac valve replacement of bicuspid valve or aortic valve, 43 cases of double cardiac valve replacement of bicuspid valve and aortic valve ; there were 145 cases of rheumatic lesions and 111 cases of non-rheumatic lesions. Platelet count was more than 100×10^9/L in all cases before surgeries; and in the first week after surgeries, platelet count was rechecked repeatedly, and the eardiopulmonary bypass time, aortic clamping time, mechanical ventilation time and the stay time in intensive care unit were recorded, respectively, Platelet count measurements were obtained from 3 months to 6 months after operation. Results： （1） In the first week after surgeries, there were 113 cases of thrombocytopenia （ 〈 100 ×10^9/L） , the incidence being 43.7% , and their cardiopulmonary bypass time, mechanical ventilation time and the length of ICU stays were longer compared with those of patients with non-thromboeytopenla.（2）There were 35 cases in single valve replacement of biological valve involving 28 cases of thromhocytopenia, the incidence being 80% ; and there were 62 cases of thrombucytopenia in 178 cases of single valve replacemenl of mechanical prosthetic valve, the incidence being 34. 8% ; comparison on both groups suggested （P = 0. 000）. （3）The incidence of thrombocytopenia was 53.5% in double mechanical prosthetic valve replacement, which compared with single valve re- placement of mechanical prosthetic valve, indicating （ P = 0. 019）. （3）The incidence of thrombocytopenia was 54. 5% in patients of the rheumatic lesion group, and 30. 6% in patients of the non-rheumatic lesion group（ P = 0. 000）. （4）There were 2 eases of death in the thrombocytopenia group, and no death in the non-thrombocytopenia group （P = 0. 194） ; （5）There wasnt patient showed thrombocytopenia from 3 months to 6 months after operation in 252 eases（99. 2% ）. Conclusion： Prolonged cardiopulmonary bypass time, and the use of biological valve and double valvereplacement, and rheumatic lesions easilyresuh in thrombocytopenia; thrombocytopenia patients have longer length of mechanical ventilation application and the stay time in intensive care unit.