摘要
目的探讨静脉留置针封管用肝素诱导的血小板减少症(HIT)的临床特点。方法分析2010年1月-2011年12月,在1 215例静脉留置针肝素封管患者中发生的14例HIT患者的临床表现,血小板(PLT)、HIT抗体的变化,氯吡格雷、阿加曲班、地塞米松等治疗的结果。结果 1 215例患者中:发生HIT 14例,发生率1.15%;HIT并血栓形成综合征4例,发生率0.33%。14例HIT患者中:经典型12例,占85.7%。出血7例,发生率50.0%,其中1级、2级出血发生率分别为42.9%(6/14)、7.1%(1/14),分别占出血的85.7%(6/7)、14.3%(1/7)。血栓形成4例,发生率28.6%,其中静脉血栓3例,占血栓形成的75.0%。14例均发生于肝素封管后第1～14天,其中第6～7天8例,占57.1%。PLT降低到最低值的时间为肝素封管后2～10 d内,其中2～5 d内13例,占92.9%。PLT降低的最低值为(1.81～101)×109/L,其中PLT(20～70)×109/L12例,占85.7%;PLT降至最低时下降的比值为51.1%～90.1%,其中50%～80%10例、占71.4%。1例至28 d死亡时血小板没有恢复至肝素封管前水平,其余13例患者PLT减少持续时间5～13 d,其中5～10 d 10例,占76.9%。14例(100%)HIT患者HIT抗体阳性,其中13例(92.9%)在PLT开始减少时即阳性,1例在PLT减少2周后呈阳性。14例HIT患者中12例(85.8%)痊愈,1例(7.1%)脑血栓后遗症,1例(7.1%)死于急性肺栓塞。结论静脉留置针封管用肝素可导致HIT,PLT减少及血栓、HIT抗体是诊断的可靠依据。及时停用肝素,必要时抗凝、抗PLT、类固醇激素治疗效果好,部分患者进展快,死亡率高。
Objective To investigate the clinical characteristics of heparin induced thrombocytopenia（HIT） by heparin for sealing venous remaining needle.Methods？The clinical manifestations,changes of PLT and HIT antibody,and treatment results by Clopidogrel Hydrogen Shlfate（Plavix）,Argatroban and Dexamethasone of 14 HIT patients were analyzed in 1 215 cases applied with heparin for sealing venous remaining needle from Jaunary 2010 to December 2011.Results The incidence of HIT was 1.15%（14/1 215）,and that of HIT with thrombosis syndrome（HITTS） was 0.33%（4/1 215）.Among the 14 HIT patients,classical types accounted for 85.7%（12/14）.The incidence of hemorrhage was 50%（7/14）,grade 1 and grade 2 hemorrhage respectively being 42.9%（6/14） and 7.1%（1/14） accounting for 85.7%（6/7） and 14.3%（1/7） in the hemorrhage patients.The incidence of thrombosis was 28.6%（4/14）,among which venous thrombosis accounted for 75.0%（3/4）.The occurrence time of thrombocytopenia was 1 to 14 days after using heparin.Eight patients developed the disease 6 to 7 days after using heparin,accounting for 57.1%（8/14）.Within 2 to 10 days,PLT decreased to the lowest level,and patients with the lowest level of PLT 2 to 5 days after using heparin accounted for 92.9%（13/14）.The lowest PLT was（1.81-101）×109/L,and patients with a level of（20-70）×109/L accounted for 85.7%（12/14）.The decrease ratio at the lowest level of PLT was 51.1% to 90.1%,and patients with a ratio of 50% to 80% accounted for 71.4%（10/14）.The duration of thrombocytopenia of 13 cases was 5 to 13 days,and patients with a duration of 5 to 10 days accounted for 76.9%（10/13）.One patient did not resume to former PLT level and died 28 days later.HIT positive antibody was found in 14 patients（100%）,among whom 13（92.9%） were positive at the beginning of thrombocytopenia,and one（7.1%） became positive after two weeks of thrombocytopenia.Among the 14 HIT patients,12（85.8%） were cured,1（7.1%） had a sequela of c
出处
《华西医学》
CAS
2013年第1期94-97,共4页
West China Medical Journal
关键词
肝素
封管
血小板减少
血栓
静脉留置针
Heparin
Sealing
Thrombocytopenia
Thrombosis
Venous remaining needle
