摘要
目的探讨心血管手术后血小板的动态变化规律、与血小板减少相关的危险因素,以及血小板减少与患者预后的相关性。方法 2008年11月-2009年9月接受心血管手术的患者99例,其中男性61例,女性38例,年龄56.6±12.1(19～85)岁。记录患者术后第1、2、3、5、7、9天时的血小板计数结果。按治疗结果将99例患者分为正常组(n=66)、感染组(n=23)和死亡组(n=10),分析各组间血小板的变化规律和差异性;按血小板是否减少将99例患者分为血小板减少组(n=51)和非小板减少组(n=48),比较两组间的感染率和死亡率;采用logistic回归对术后血小板减少的危险因素及血小板减少与死亡率的相关性进行统计分析。结果心血管术后患者血小板于第3天降至最低,之后逐渐上升,感染组和死亡组下降幅度明显大于正常组(P<0.01)。术后血小板减少组的感染率和死亡率均明显高于非血小板减少组(54.9%vs6.3%,χ2=27.213,P=0.000;19.6%vs4.2%,χ2=5.535,P=0.019)。年龄和体外循环转流时间与术后血小板减少的发生显著相关,年龄越大、转流时间越长,术后血小板减少越明显(年龄χ2=7.337,P=0.007,OR=0.943;转流时间χ2=14.666,P=0.000,OR=0.977)。术后血小板减少与近期死亡之间有明显的相关性(χ2=4.603,P=0.032,OR=0.178)。结论心血管术后血小板减少的患者感染率和死亡率均明显增高;年龄和体外循环转流时间是术后血小板减少的危险因素,而术后血小板减少是死亡的危险因素。
Objective To explore the dynamic changes of platelet count in patients after cardiovascular operation,the risk factors inducing plate-reduction,and prognostic value of thrombocytopenia.Methods Ninety-nine patients,consisted of 61males and 38females with average age of 56.6±12.1（19―85）yrs,received cardiovascular operation from Nov.2008to Sep.2009.The age,gender,operation type,cross clamping time,bypass time,correlative outcomes and platelet counts at 1,2,3,5,7and 9days after cardiovascular operation were recorded.The patients were divided into normal group（n=66）,infection group（n=23）and death group（n=10） according to the therapeutic results,the changes and variations of platelet counts in the three groups were analyzed.Meanwhile,the patients were divided into thrombocytopenia group（n=51）and non-thrombocytopenia group（n=48）according to the postoperative platelet count,and the infection rate and mortality were analyzed.The risk factors of postoperative thrombocytopenia and correlation between thrombocytopenia and mortality were analyzed by logistic regression analysis.Results After cardiovascular operation,the platelet count decreased significantly on the 3rd day in all patients and then raised gradually,and the damping was larger in infection group and death group than in normal group（P0.01）.The infection rate and mortality were significantly higher in thrombocytopenia group than in non-thrombocytopenia group（54.9%vs 6.3%,χ2=27.213,P=0.000;19.6%vs 4.2%,χ2=5.535,P=0.019）.The postoperative thrombocytopenia was closely associated with patients＇age and bypass time（age：χ2=7.337,P=0.007,OR=0.943;bypass time：χ2= 14.666,P=0.000,OR=0.977）.There was a significantly association between postoperative thrombocytopenia and mortality（χ2= 4.603,P=0.032,OR=0.178）.Conclusions Infection rate and mortality may increase in patients with postoperative thrombocytopenia. Age and bypass time are the risk factors of postoperative thrombocytopenia,and postoperative thrombocytopenia is the
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2010年第9期1145-1147,共3页
Medical Journal of Chinese People's Liberation Army
关键词
血小板减少
心血管外科手术
危险因素
预后
thrombocytopenia
cardiovascular surgical procedures
risk factors
prognosis
