摘要
目的探讨人工二尖瓣膜置换术后早期血小板聚集性变化规律。方法本院心血管外科住院手术患者90例,其中男性39例,女性51,年龄(26.0±8.1)岁。分为3组,分别为成人先天性心脏病组、二尖瓣置换窦性心律组、二尖瓣置换房颤心律组,每组30例。人工瓣膜均为双叶瓣。分别取术前,术后2、4、6d及术后1个月血液样本,利用Chrono-log公司500CA型血小板聚集仪,分别测定5、10μmol/LADP,2μg/mlcollagen刺激时的血小板聚集性。结果体外循环术后成人先心组血小板聚集性与术前比较无明显差异(P>0.05)。二尖瓣置换组血小板聚集性成先下降后上升的趋势,于术后4d达到最高水平。其中房颤心律组ADP(5μmol/L)为(14.56±2.32)Ω,ADP(10μmol/L)为(17.86±2.43)Ω,collagen(2μg/ml)为(21.60±2.60)Ω,与同期成人先心组和窦性心律组比差异有统计学意义(P<0.05)。房颤组术前、术后4d血小板聚集性均较成人先心组、窦性心律组高(P<0.05)。结论二尖瓣置换患者术后早期血小板聚集性变化明显,以1周内尤为显著,发生血栓栓塞风险大,其中合并房颤的患者变化最明显。
Objective To observe the change of the platelet aggregation in early stage of patients after mitral valve replacement. Methods Ninety patients （ male 39, female 51, with an average age of 26.0 ± 8.1 ） who underwent cardiac surgery with cardiopulmonary bypass （CPB） from September to December 2009 in our department were divided into 3 groups, congenital heart disease （n = 30）, mitral valve replacement with sinus rhythm （n = 30）, and mitral valve replacement with atrial fibrillation （n = 30 ）. All the prostheses were bileaflet mechanical valves. Blood was sampled at the following time points： on the day before surgery, on the 2nd, 4th, 6th postoperative day and on the day after 1 month. Platelet aggregation was measured with stimulation by adenosine diphosphate （ADP, 5 and 10 μmol/L） and collagen （2 μg/ml）. Results Platelet aggregation in congenital heart disease group showed no statistically significant difference with that before operation （ P 〉 0. 05 ）. Platelet aggregation was decreased on the 2nd postoperative day and significantly increased on the 4th postoperative day （P 〈0.05）, and the result of ADP （5 and 10 μmol/L） and collagen （2μg/ml） was （14.56±2.32）, （17.86 ±2.43） and （21.60 ±2.60） Ω in the patients with atrial fibrillation. Platelet aggregation in the patients with atrial fibrillation was higher than those in the congenital heart disease group and mitral valve replacement with sinus rhythm group on the day before surgery and on the 4th postoperative day （P 〈 0.05 ）. Conclusion Platelet aggregation shows significant change in mitral replacement during postoperative period, especially within 1 week. We need to pay more attention to patients because of high risk of thromboembolism.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2010年第9期982-984,共3页
Journal of Third Military Medical University
关键词
心脏瓣膜置换
血小板
血栓
heart valve prosthesis
platelet
thrombosis valve these
