小儿动脉导管未闭介入封堵术后严重血小板减少临床分析

程真莉; 李谧; 吕铁伟; 向平; 白永虹; 计晓娟; 刘云黎; 蒲晓芳; 易岂建

doi:10.16016/j.1000-5404.201703030

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小儿动脉导管未闭介入封堵术后严重血小板减少临床分析

临床医学 | 更新时间：2026-01-09

- 小儿动脉导管未闭介入封堵术后严重血小板减少临床分析
- Severe thrombocytopenia after transcatheter closure of patent ductus arteriosus in children: analysis of 11 cases
- 第三军医大学学报 2017年39卷第14期页码：1486-1492
- 作者机构：
  
  400014 重庆，重庆医科大学附属儿童医院心血管内科，儿童发育疾病研究省部共建教育部重点实验室、儿科学重庆市重点实验室、重庆市儿童发育重大疾病诊治与预防国际科技合作基地
- 作者简介：
  
  [ 易岂建, E-mail: 1105643760@qq.com YI Qijian, E-mail: 1105643760@qq.com
- 基金信息：
  
  重庆市卫生局医学科研计划项目(重点项目)(2011-1-065)
- DOI：10.16016/j.1000-5404.201703030
  中图分类号： R619; R725.411; R725.582
- 收稿：2017-03-05，
  
  修回：2017-04-10，
  
  纸质出版：2017-07-30
- 稿件说明：
移动端阅览
程真莉, 李谧, 吕铁伟, 等. 小儿动脉导管未闭介入封堵术后严重血小板减少临床分析[J]. 第三军医大学学报, 2017,39(14):1486-1492.

Zhenli CHENG, Mi LI, Tiewei LV, et al. Severe thrombocytopenia after transcatheter closure of patent ductus arteriosus in children: analysis of 11 cases[J]. Journal of Third Military Medical University, 2017, 39(14): 1486-1492.
程真莉, 李谧, 吕铁伟, 等. 小儿动脉导管未闭介入封堵术后严重血小板减少临床分析[J]. 第三军医大学学报, 2017,39(14):1486-1492. DOI： 10.16016/j.1000-5404.201703030.

Zhenli CHENG, Mi LI, Tiewei LV, et al. Severe thrombocytopenia after transcatheter closure of patent ductus arteriosus in children: analysis of 11 cases[J]. Journal of Third Military Medical University, 2017, 39(14): 1486-1492. DOI： 10.16016/j.1000-5404.201703030.

摘要

目的

探讨动脉导管未闭(patent ductus arteriosus，PDA)介入封堵术后严重血小板减少的原因。

方法

收集重庆医科大学附属儿童医院2006年1月至2016年11月PDA介入封堵术后发生严重血小板减少的病例，分析严重血小板减少发生的高危因素、诊治措施及预后。

结果

共收集介入封堵PDA患儿848例，其中发生严重血小板减少11例，发生率为1.29%。11例患儿年龄(1.4±0.5) 岁，包括男性3例，女性8例。降主动脉造影测PDA直径为(7.9±3.0) mm，选择封堵器前伞直径8~18(11.6±2.5) mm，术后1 d复查心脏超声发现7例患儿有不同程度残余分流。患儿术前血小板为(261.0±74.9)×10

/L，术后血小板最低下降至(23.4±9.3)×10

/L。8例发生于术后第1~3天，2例发生于术后第4天，1例发生于术后第6天；8例出现皮肤出血点，3例合并鼻衄，1例合并溶血，6例合并中度贫血(Hb：71~86 g/L)，所有病例无重要脏器出血。8例术后1~3 d出现发热，1例合并穿刺处巨大血肿。除1例21-三体综合征患儿合并室间隔缺损封堵术后出现顽固性血小板减少和溶血，内科治疗3周无效转外科手术后血小板恢复外，其余经止血、输注血小板、激素、丙种球蛋白等内科治疗后，9例于术后2周内血小板恢复正常，1例于术后第8周恢复正常。

结论

PDA介入封堵术后严重血小板减少的发生可能与PDA直径较大、封堵器直径较大、残余分流、术后感染、穿刺处血肿有关，经正规内科保守治疗，预后良好。

Abstract

Objective

To explore the causes of thrombocytopenia following transcatheter closure of patent ductus arteriosus (PDA) in children.

Methods

The clinical data were collected from children who experienced thrombocytopenia following transcatheter closure of PDA in our hospital between January 2006 and November 2016.

Results

Among the total of 848 children undergoing transcatheter device closure of PDA in our hospital

11 (3 boys and 8 girls) developed severe thrombocytopenia after the procedure with an incidence of 1.29%. The mean age of the 11 children was 1.4

±0.5 years

and the mean diameter of PDA was 7.9±3.0 mm as measured by cardiac catheterization; the mean size of the occluder used was 11.6±2.5 mm (range 8-18 mm). Residual shunts were found on the first day after the operation in 7 cases.The mean platelet count of the 11 children was (261.0±74.9)×10

/L before the operation

and was lowered to (23.36±9.26)×10

/L after the operation. Thrombocytopenia occurred within 3 d after the operation in 8 cases

on the 4th day in 2 cases

and on the 6th day in 1 case. The clinical manifestations included hemorrhagic skin rashes (8 cases) and nasal hemorrhage (3 cases)

but none of the children had hemorrhage in the vital organs. One child had hemolysis

and 6 children showed moderate anemia (Hb of 71-86 g/L). Eight children experienced fever within 3 d after transcatheter closure

and one child had a huge puncture hematoma in the right inguinal fold. Nine children fully recovered after treatment with medications within 2 weeks and one child recovered within 8 weeks. One child with Down syndrome combined with PDA and ventricular septal defect treated by interventional therapy had refractory hemolysis and thrombocytopenia after the operation. The patient failed to respond to a 3-week medication therapy and was subsequently transferred for surgery to remove the occluders

after which the platelet count recovered the normal level.

Conclusion

The possible causes of thrombocytopenia following transcatheter closure of PDA in children include the size of PDA

use of large-diameter occluders

residual shunt after the operation

postoperative infection

and huge puncture hematoma.

关键词

Keywords

references

《中华儿科杂志》编委会, 《中华医学杂志》编辑委员会.先天性心脏病经导管介入治疗指南[J].中华儿科杂志, 2004, 42(3): 234-239. DOI: 10.3760/j.issn:0578-1310.2004.03.26.

Editorial Committee of Chinese Journal of Pediatrics , Editorial Committee of National Medical Journal of China. Guidelines for transcatheter interventional treatment of congenital heartdisease[J ] . Chin J Pediatr, 2004, 42(3): 234-239. DOI: 10.3760/j.issn: 0578-1310.2004.03.26..

蒋秋静, 肖年, 曹奕, 等.重庆市2006-2015年5岁以下儿童死亡率及死因构成的变化趋势[J].第三军大学学报, 2016, 38(23): 2548-2551. DOI: 10.16016/j.1000-5404.2016.06.016.

JIANG Q J, XIAO N, CAO Y, et al. Trend analysis on mortality and causes of death for children under 5 years old in Chongqing during 2006-2015[J]. J Third Mil Med Univ, 2016, 38(23): 2548-2551. DOI: 10.16016/j.1000-5404. 2016.06.016.

鞠叶兰, 王晨虹, 程黎, 等. 1131例先天性心脏病患者监测结果分析[J].中国妇幼保健, 2016, 31(8): 1 658-1661. DOI: 10.7620/zgfybj.j.issn.1001-4411.2016.08.33.

JU Y L, WANG C H, CHENG L. Analysis on monitoring results of 1131 patients with congenital heart diseases[J]. Maternal Child Health Care China, 2016, 31(8): 1658-1661. DOI: 10. 7620/zgfybj.j.issn.1001-4411.2016. 08.33.

中国医师协会心血管内科分会先心病工作委员会.常见先天性心脏病介入治疗中国专家共识-动脉导管未闭的介入治疗[J].介入放射学杂志, 2011, 20(3): 172-176. DOI: 10.3969 /j.issn.1008-794X.2011.03.002.

Committee on Congenital Heart Diseases, Internal Medicine Branch of Cadiovascular Diseases, Chinese Physicians' Association.Interventional treatment of common congenital heart diseases:the common view of Chinese medical experts-Interventional treatment of patient ductus arteriosus[J]. J Interventi Radiol, 2011, 20(3): 172-176. DOI: 10.3969/j.issn.1008-794X.2011.03.002.

蔡仕俊, 阮兢, 张励庭.动脉导管未闭封堵术后血小板减少1例[J].岭南心血管杂志, 2015, 21(5):708, 711. DOI:10.3969/j.issn, 1007-9688.2015.05.032.

CAI S J, RUAN J, ZHANG L T. Thrombocytopenia after transcatheter closure of patent ductus arteriosus: a report of 1 cases[J]. South China J Cardiovasc Dis, 2015, 21(5): 708, 711. DOI: 10.3969/j.issn, 1007-9688.2015.05.032.

胡梵, 王一斌, 乔莉娜.动脉导管未闭介入术后血小板减少3例报告[J].临床儿科杂志, 2011, 29(11): 1040. DOI: 10. 3969/j.issn.1000-3606.2011.11.010.

HU F, WANG Y B, QIAO L N. Report of 3 cases of thrombocytopenia after transcatheter closure of patent ductus arteriosus[J]. J Clin Pediatr, 2011, 29(11): 1040. DOI: 10.3969/j.issn.1000-3606.2011.11.010.

田野, 刘晓桥, 张萍, 等.动脉导管未闭介入封堵术后血小板急剧减少3例[J].中华心血管病杂志, 2012, 40(4): 340-341. DOI: 10.3760/cma.j.issn.0253-3758.2012.04.017.

TIAN Y, LIU X Q, ZHANG P et al.Three cases of thrombocytopenia after transcatheter closure of patent ductus arteriosus[J]. Chin J Cardiol, 2012, 40(4): 340-341. DOI: 10.3760/cma.j.issn.0253-3758.2012.04.017.

廖祁伟, 张伟华, 鲁一兵, 等.动脉导管未闭介入封堵术后血小板减少的相关因素分析[J].中华心血管病杂志, 2013, 41(3): 229-232. DOI: 10.3760 /cma.j.issn.0253-3758.2013.03.012.

LIAO Q W, ZHANG W H, GUANG X F, et al. Retrospective analysis of patients with thrombocytopenia after patent ductus arteriosus interventional occlusion[J]. Chin J Cardiol, 2013, 41(3): 229-232. DOI:10.3760 /cma.j.issn.0253-3758.2013.03.012

陈亮, 单兴华, 秦永文, 等.先天性心脏病封堵术后的血小板减少症及对策[J].国际心血管病杂志, 2013, 41(3): 161-166. DOI: 10.3969/j.ISSN.1673-6583.2014.03.009.

CHEN L, SHAN X H, QIN Y W, et al.Thrombocytopenia after transcatheter closure of congenital heart disease and Its Countermeasures[J]. Inter J Cardiovasc Dis, 2013, 41(3): 161-166. 1111111155555555

WU B, RONG R. Thrombocytopenia in patients with patent ductus arteriosus after transcatheter closure: perilous complication or harmless incidental finding? [J]. Blood Transfus, 2013, 11(3): 477-478. DOI: 10.2450/2012.0159-12.

祝金明, 孙延霞, 张兆志, 等.动脉导管未闭介入封堵术合并骨髓嗜血现象1例报告[J].中国介入心脏病学杂志, 2011, 19(5): 286-287. DOI: 10.3969/j.issn.1004-8812.2011.05.015.

ZHU J M, SUN Y X, ZHANG Z Z, et al.Transcatheter closure of patent ductus arteriosus and hemophagocytic syndrome:one case report[J]. Chin J Interv Cardiol, 2011, 19(5): 286-287. DOI: 10.3969/j.issn.1004-8812.2011.05.015.

卢竟前, 吕云, 李易.与动脉导管未闭介入封堵相关的血小板减少症三例临床分析[J].中国介入心脏病学杂志, 2010, 18(5): 299-300. DOI: 10.369/j.issn.1004-8812.2011.05.015.

LU J Q, LYU Y, LI Y. Clinical analysis of three cases of thrombocytopenia associated with transcatheter closure of patent ductus arteriosus[J]. Chin J Interv Cardiol, 2010, 18(5): 299-300. 1111111155555555

ZHANG P, ZHU X Y. Severe thrombocytopenia complicating transcatheter occlusion of patent ductus arteriosus[J].J Invasive Cardiol, 2013, 25(5): E88-92. DOI: 10.3969/j.issn.1006-1959.2016.13.173.

张长海, 田野, 刘晓桥, 等.一种新的先天性心脏病动脉导管未闭介入封堵器[J].医学信息, 2016, 29(13): 226. DOI: 10.3969/j.issn.1006-1959.2016.13.173.

ZHANG C H, TIAN Y, LIU X Q, et al.A new occlude fortranscatheter closure of patent ductus arteriosus of congenital heart disease[J]. Med Inform, 2016, 29(13): 226. DOI: 10.3969/j.issn.1006-1959.2016.13.173.

解启莲, 张密林, 王震, 等.动脉导管未闭患儿介入封堵术后并发血小板减少症3例[J].中华医学杂志, 2005, 85(36): 2535. DOI: 10.3760/j:issn:0376-2491.2005.36.025.

JIE Q L, ZHANG M L, WANG ZHEN, et al.Thrombocytopenia after transcatheter closure of patent ductus arteriosus: a report of 3 cases[J]. National Med J China, 2005, 85(36): 2535. DOI: 10.3760/j:issn:0376-2491.2005.36.025.

梁静, 周玉杰, 史冬梅, 等.动脉导管未闭封堵术后血小板减少一例[J].中国介入心脏病学杂志, 2008, 16(5): 287. DOI: 10.3969/j.issn.1004-8812.2008.05.015.

LIANG J, ZHOU Y J, SHI D M, et al. A case of thrombocytopenia after transcatheter closure of patent ductus arteriosus[J]. Chin J Interv Cardiol, 2008, 16(5): 287. DOI: 10.3969/j.issn.1004-8812.2008.05.015.

张立平, 丁盛, 杨永健, 等.动脉导管未闭封堵术后血小板减少原因分析及防治[J].临床心血管病杂志, 2013, 21(1): 21-24. DOI: 10.13201/j.issn.1001-1439.2013.02.017.

ZHANG L P, DING S, YANG Y J, et al.Cause analysis and prevention of thrombocytopenia after transcatheter closure of patent ductus arteriosus[J]. J Clin Cardiol, 2013, 21(1): 21-24. DOI: 10.13201/j.issn.1001-1439.2013.02.017.

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