胸主动脉夹层动脉瘤腔内隔绝术后血小板减少的临床分析

Thrombocytopenia after endovascular graft exclusion for Stanford B dissecting aneurysm of thoracic aorta

目的 观察胸主动脉夹层动脉瘤腔内隔绝术 (endovascular graft exclusion,EVGE)后血小板改变 ,分析血小板减少的原因 ,并探讨降低血小板减少幅度的措施。 方法 对 12 4例胸主动脉夹层动脉瘤患者成功施行了EVGE,并于术前 ,术后 2小时 ,术后 1、2、3、4、7和 14天连续采集周围静脉血标本 ,观察血小板计数的变化。 结果10 6例 (85 .5 % )术后出现血小板计数减少 ,血小板减少幅度为术前水平的 30 .3%～ 6 9.3%。第 1～ 2天最低 ,为 (89.5 2± 19.4 7)× 10 9/ L (P<0 .0 5 ) ,此后逐渐回升。出现继发性血小板增多 5 1例。 结论 EVGE后血小板减少常见 ,其发生原因较多 ,移植物、内皮损伤、肝素、血小板滞留、失血和输血是血小板激活和减少的主要因素。采取适当的措施 ,可能有助于降低血小板减少的幅度 ,避免术后发生出血并发症。

Objective To observe the changes in platelet count after endovascular graft exclusion (EVGE) for Stanford B dissecting aneurysm of thoracic aorta, analyse the cause of thrombocytopenia and prevention. Methods One hundred twenty-four consecutive patients underwent EVGE for Stanford B dissecting aneurysm of thoracic aorta successfully .In order to observe the change tendency in platelet count, a serial peripheral venous blood specimens was collected from all patients at the day before EVGE, after EVGE 2 h,1, 2, 3, 4, 7, and 14 day. Results After EVGE, decreased platelet count were occurred in 106(85.5%) patients. The extent of decreased platelet count was from 30.3 to 69.3 percent of preoperative value. There was a significant fall in platelet count [lowest(89.52±19.47)×109/L,P<0.05] during the preceding two days after EVGE, which was followed by gradually increase and furthermore thrombocytosis in 51 patients. Conclusions Thrombocytopenia occurs frequently after EVGE for dissecting aneurysm of thoracic aorta. The reasons are multi-factor-related. Endovascular graft, endothelium injury, heparin therapy, platelet sequestration, blood loss and blood transfusion are the important roles in platelet activation and thrombocytopenia. Thrombocytopenia and it's complication maybe attenuated and prevented by appropriate measures after EVGE.