儿童肝移植术后肝素诱导的血小板减少症临床分析
发布时间：2018-08-21 07:23
【摘要】：目的:肝素是肝移植术后最常使用的抗凝剂之一,主要用于动静脉血栓的预防及治疗。肝素的应用可导致血小板减少,即肝素诱导的血小板减少症(HIT),临床危害大。目前对肝移植后的HIT报道较少,尤其对儿童肝移植后HIT的研究更未见报道。在临床工作中,医务人员对HIT重视不够,并对其可能造成血栓形成的严重的后果认识不足。本研究对儿童肝植术后HIT的临床资料进行总结,探讨儿童肝移植术后发生HIT的临床特点,并探讨安全使用肝素的临床策略。方法:回顾性分析2006年6月至2015年3月重庆医科大学附属儿童医院64例肝移植患儿的临床资料。男30例,女34例,年龄2个月?15岁,中位年龄8个月;根据年龄分组,分为婴幼儿组(年龄3岁)47例,大龄组(年龄3岁)17例。根据使用肝素不同,分为普通肝素(UFH)组41例,低分子肝素(LMWH)组23例。UFH组中,年龄3岁8例,3岁33例。原发病中,胆道闭锁42例,肝豆状核变性6例,肝糖原累积症6例,门静脉海绵样变、原发性肝硬化及胆汁性肝硬化各3例,急性重症肝炎1例。检测所有患儿住院期间的血小板计数,收集患儿相关临床信息,包括患儿年龄、性别、原发病、肝移植方式、既往肝素接触史,肝素使用方式以及使用时间、住院时间、血管栓塞、皮肤病损发生情况以等并发症以及预后情况。用SPSS 20.0统计软件包进行数据分析,分析HIT发病率,分析患儿年龄、肝素类型与HIT的关系,以及HIT与患儿预后的关系。结果:64例肝移植患儿,UFH组41例,其中5例(5/41,12.2%)发生HIT,HIT病人中3例女性,2例男性;UFH组中,3岁的婴幼儿2例(2/33,6.1%),3岁的患儿3例(3/8,37.5%),组间差异有统计学意义(P0.05);低分子肝素组23例中无HIT病例。5例HIT病人中,3例(3/5,60%)于术后30天内死亡,其中2例发生术后肝动脉血栓。未发生HIT的59例病人术后30天内死亡9例(9/59,15.3%),与HIT病人相比,有统计学意义(P0.05)。结论:儿童肝移植术后,HIT可能是导致患儿围手术期死亡率升高的原因之一。UFH较LMWH的发生率高,年龄3岁的患儿在使用肝素过程中更容易发生HIT,因此在3岁儿童应尽量避免使用UFH。儿童肝移植术用肝素治疗时,应重视对病情的观察,尽早发现并明确HIT的诊断,减少HIT的发生。
[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.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：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.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.5
【参考文献】
相关期刊论文 前3条
1 刘t熻，
本文编号：2194975
本文链接：https://www.wllwen.com/yixuelunwen/eklw/2194975.html
最近更新
教材专著
