经导管主动脉瓣置换术后血小板变化特点及影响因素分析

Analysis of the characteristics of platelet changes and influencing factors after transcatheter aortic valve implantation

目的分析行经导管主动脉瓣置换术(transcatheter aortic valve implantation,TAVI)患者术后在院期间血小板变化特点及其影响因素。方法回顾性纳入2017年3月—2021年10月在北京安贞医院瓣膜外科中心行TAVI患者,根据患者术后血小板下降特点分为血小板变化自限性组和非自限性组。比较两组患者的术前一般资料、术前及术后超声资料、术中操作资料和术后在院期间抗血栓药物使用情况。结果最终纳入患者249例,自限性组175例(70.3%),其中男100例、女75例;非自限性组74例(29.7%),其中男43例、女31例,两组患者性别差异无统计学意义(P=0.863)。自限性组患者平均年龄为(73.11±8.88)岁,非自限性组为(71.54±10.39)岁,差异无统计学意义(P=0.231)。自限性组一般于术后第2 d发生血小板下降,并于术后第4 d达计数最低点,于术后第5~7 d恢复至基线水平;非自限性组血小板变化为单纯上升、下降或无规律波动。自限性组患者术前主动脉瓣狭窄程度更严重(P<0.001),且术中使用更多的体外循环辅助(P<0.001)。术后自限性组患者比非自限性组患者更易出现主动脉瓣瓣周漏(P=0.013)。结论TAVI术后患者血小板变化多呈自限性下降趋势,可能与患者术前主动脉瓣狭窄严重程度、术中使用体外循环装置、术后瓣周漏有关。

Objective To analyze the characteristics of platelet changes and their influencing factors during postoperative hospitalization in patients who underwent transcatheter aortic valve implantation(TAVI).Methods The patients who underwent TAVI at Beijing Anzhen Hospital Valve Surgery Center between March 2017 and October 2021 were retrospectively selected.The patients were divided into a self-limiting group and a non-self-limiting group according to the characteristics of postoperative platelet decline.In addition,the general preoperative data,preoperative and postoperative ultrasound data,intraoperative data,and the use of anticoagulant drugs during the postoperative stay in the hospital were compared between the two groups.Results A total of 249 patients were enrolled in this study.There were 175(70.3%)patients in the self-limiting group,including 100 males and 75 females,and there were 74(29.7%)patients in the non-self-limiting group,including 43 males and 31 females,with no statistical difference between the two groups(P=0.863).The mean age of patients was 73.11±8.88 years in the self-limiting group and 71.54±10.39 years in the non-selflimiting group(P=0.231).The decline of platelets in the self-limiting group generally occurred on the postoperative day 2 and reached the lowest count on the postoperative day 4,and returned to the baseline level on the postoperative day 5-7,while the platelets in the non-self-limiting group changed by simple rise,fall or irregular fluctuation.Patients in the selflimiting group had severer preoperative aortic stenosis(P<0.001)and used more extracorporeal circulation assistance during surgery(P<0.001).Postoperatively,patients in the self-limiting group were more likely to have periaortic valve leakage than those in the non-self-limiting group(P=0.013).Conclusion Platelet changes in most patients after TAVI show a self-limiting decline,which may be related to the severity of patients’preoperative aortic stenosis,intraoperative extracorporeal circulation device use,and postoperative perivalvular leakage.