兒童肝移植術(shù)后肝素誘導(dǎo)的血小板減少癥臨床分析
發(fā)布時(shí)間：2018-08-21 07:23
【摘要】：目的:肝素是肝移植術(shù)后最常使用的抗凝劑之一,主要用于動(dòng)靜脈血栓的預(yù)防及治療。肝素的應(yīng)用可導(dǎo)致血小板減少,即肝素誘導(dǎo)的血小板減少癥(HIT),臨床危害大。目前對肝移植后的HIT報(bào)道較少,尤其對兒童肝移植后HIT的研究更未見報(bào)道。在臨床工作中,醫(yī)務(wù)人員對HIT重視不夠,并對其可能造成血栓形成的嚴(yán)重的后果認(rèn)識(shí)不足。本研究對兒童肝植術(shù)后HIT的臨床資料進(jìn)行總結(jié),探討兒童肝移植術(shù)后發(fā)生HIT的臨床特點(diǎn),并探討安全使用肝素的臨床策略。方法:回顧性分析2006年6月至2015年3月重慶醫(yī)科大學(xué)附屬兒童醫(yī)院64例肝移植患兒的臨床資料。男30例,女34例,年齡2個(gè)月?15歲,中位年齡8個(gè)月;根據(jù)年齡分組,分為嬰幼兒組(年齡3歲)47例,大齡組(年齡3歲)17例。根據(jù)使用肝素不同,分為普通肝素(UFH)組41例,低分子肝素(LMWH)組23例。UFH組中,年齡3歲8例,3歲33例。原發(fā)病中,膽道閉鎖42例,肝豆?fàn)詈俗冃?例,肝糖原累積癥6例,門靜脈海綿樣變、原發(fā)性肝硬化及膽汁性肝硬化各3例,急性重癥肝炎1例。檢測所有患兒住院期間的血小板計(jì)數(shù),收集患兒相關(guān)臨床信息,包括患兒年齡、性別、原發(fā)病、肝移植方式、既往肝素接觸史,肝素使用方式以及使用時(shí)間、住院時(shí)間、血管栓塞、皮膚病損發(fā)生情況以等并發(fā)癥以及預(yù)后情況。用SPSS 20.0統(tǒng)計(jì)軟件包進(jìn)行數(shù)據(jù)分析,分析HIT發(fā)病率,分析患兒年齡、肝素類型與HIT的關(guān)系,以及HIT與患兒預(yù)后的關(guān)系。結(jié)果:64例肝移植患兒,UFH組41例,其中5例(5/41,12.2%)發(fā)生HIT,HIT病人中3例女性,2例男性;UFH組中,3歲的嬰幼兒2例(2/33,6.1%),3歲的患兒3例(3/8,37.5%),組間差異有統(tǒng)計(jì)學(xué)意義(P0.05);低分子肝素組23例中無HIT病例。5例HIT病人中,3例(3/5,60%)于術(shù)后30天內(nèi)死亡,其中2例發(fā)生術(shù)后肝動(dòng)脈血栓。未發(fā)生HIT的59例病人術(shù)后30天內(nèi)死亡9例(9/59,15.3%),與HIT病人相比,有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:兒童肝移植術(shù)后,HIT可能是導(dǎo)致患兒圍手術(shù)期死亡率升高的原因之一。UFH較LMWH的發(fā)生率高,年齡3歲的患兒在使用肝素過程中更容易發(fā)生HIT,因此在3歲兒童應(yīng)盡量避免使用UFH。兒童肝移植術(shù)用肝素治療時(shí),應(yīng)重視對病情的觀察,盡早發(fā)現(xiàn)并明確HIT的診斷,減少HIT的發(fā)生。
[Abstract]:Objective: heparin is one of the most commonly used anticoagulants after liver transplantation, mainly used in the prevention and treatment of arteriovenous thrombosis. The use of heparin can lead to thrombocytopenia, that is heparin-induced thrombocytopenia (HIT),) is a great clinical hazard. At present, there are few reports on HIT after liver transplantation, especially on HIT after liver transplantation in children. In clinical work, medical personnel pay less attention to HIT, and lack of understanding of the serious consequences of thrombus formation. This study summarized the clinical data of HIT after liver transplantation in children, and discussed the clinical characteristics of HIT in children after liver transplantation and the clinical strategy of safe use of heparin. Methods: the clinical data of 64 children with liver transplantation from June 2006 to March 2015 were analyzed retrospectively. There were 30 males and 34 females, aged from 2 months to 15 years, with a median age of 8 months. According to the age group, 47 cases were divided into infant group (age 3 years) and older group (age 3 years) 17 cases. According to the different use of heparin, the patients were divided into common heparin (UFH) group (n = 41) and low-molecular-weight heparin (LMWH) group (n = 23). Among the primary diseases, 42 cases were biliary atresia, 6 cases were hepatolenticular degeneration, 6 cases were hepatic glycogen accumulation, 3 cases were portal cavernous degeneration, 3 cases were primary cirrhosis and 3 cases were bile cirrhosis, and 1 case was acute severe hepatitis. Platelet count was measured during hospitalization, and clinical information was collected, including age, sex, primary disease, liver transplantation, past heparin exposure, heparin usage and duration of hospitalization. Vascular embolism, skin lesions and other complications and prognosis. The incidence of HIT, the relationship between age, heparin type and HIT, and the relationship between HIT and prognosis were analyzed by SPSS 20.0 software package. Results there were 41 cases of UFH group in 64 children with liver transplantation. Among them, 5 cases (5 / 41%) had hit, 3 cases were female, 2 cases were male, 2 cases were 3 years old (2 / 33%), 3 cases were 3% (3 / 837. 5%), the difference was statistically significant (P0.05), and in low molecular heparin group, there were 3 cases (3 / 837. 5%) of HIT patients without HIT. (3 / 5 or 60%) died within 30 days after surgery, Postoperative hepatic artery thrombosis occurred in 2 cases. There were 9 deaths (9 / 59 / 15. 3%) in 59 patients without HIT within 30 days after operation, which was statistically significant compared with HIT patients (P0.05). Conclusion: the incidence of perioperative mortality is higher than that of LMWH in children after liver transplantation, and it is more likely to occur in children aged 3 years during heparin use. Therefore, children aged 3 years should avoid using it as far as possible. Heparin should be paid more attention to in the treatment of children's liver transplantation, and the diagnosis of HIT should be found and confirmed as soon as possible, and the occurrence of HIT should be reduced.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R726.5
[Abstract]:Objective: heparin is one of the most commonly used anticoagulants after liver transplantation, mainly used in the prevention and treatment of arteriovenous thrombosis. The use of heparin can lead to thrombocytopenia, that is heparin-induced thrombocytopenia (HIT),) is a great clinical hazard. At present, there are few reports on HIT after liver transplantation, especially on HIT after liver transplantation in children. In clinical work, medical personnel pay less attention to HIT, and lack of understanding of the serious consequences of thrombus formation. This study summarized the clinical data of HIT after liver transplantation in children, and discussed the clinical characteristics of HIT in children after liver transplantation and the clinical strategy of safe use of heparin. Methods: the clinical data of 64 children with liver transplantation from June 2006 to March 2015 were analyzed retrospectively. There were 30 males and 34 females, aged from 2 months to 15 years, with a median age of 8 months. According to the age group, 47 cases were divided into infant group (age 3 years) and older group (age 3 years) 17 cases. According to the different use of heparin, the patients were divided into common heparin (UFH) group (n = 41) and low-molecular-weight heparin (LMWH) group (n = 23). Among the primary diseases, 42 cases were biliary atresia, 6 cases were hepatolenticular degeneration, 6 cases were hepatic glycogen accumulation, 3 cases were portal cavernous degeneration, 3 cases were primary cirrhosis and 3 cases were bile cirrhosis, and 1 case was acute severe hepatitis. Platelet count was measured during hospitalization, and clinical information was collected, including age, sex, primary disease, liver transplantation, past heparin exposure, heparin usage and duration of hospitalization. Vascular embolism, skin lesions and other complications and prognosis. The incidence of HIT, the relationship between age, heparin type and HIT, and the relationship between HIT and prognosis were analyzed by SPSS 20.0 software package. Results there were 41 cases of UFH group in 64 children with liver transplantation. Among them, 5 cases (5 / 41%) had hit, 3 cases were female, 2 cases were male, 2 cases were 3 years old (2 / 33%), 3 cases were 3% (3 / 837. 5%), the difference was statistically significant (P0.05), and in low molecular heparin group, there were 3 cases (3 / 837. 5%) of HIT patients without HIT. (3 / 5 or 60%) died within 30 days after surgery, Postoperative hepatic artery thrombosis occurred in 2 cases. There were 9 deaths (9 / 59 / 15. 3%) in 59 patients without HIT within 30 days after operation, which was statistically significant compared with HIT patients (P0.05). Conclusion: the incidence of perioperative mortality is higher than that of LMWH in children after liver transplantation, and it is more likely to occur in children aged 3 years during heparin use. Therefore, children aged 3 years should avoid using it as far as possible. Heparin should be paid more attention to in the treatment of children's liver transplantation, and the diagnosis of HIT should be found and confirmed as soon as possible, and the occurrence of HIT should be reduced.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R726.5
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