Ishida Keiichi, Imamaki Mizuho, Ishida Atsushi, Shimura Hitoshi, Miyazaki Masaru
Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-0856, Japan.
Surg Today. 2004;34(12):1041-3. doi: 10.1007/s00595-004-2867-5.
A 79-year-old man was transferred to our hospital with severe chest pain and a suspected diagnosis of acute myocardial infarction. Emergency cardiac catheterization showed triple-vessel coronary artery disease, and we performed coronary artery bypass grafting under cardiopulmonary bypass (CPB). Continuous hemodiafiltration was started for acute renal failure postoperatively, and heparin was given as an anticoagulanting agent. By 9 days after the initiation of heparin therapy, his platelet count had fallen and a deep vein thrombosis had formed in his left leg. We suspected heparin-induced thrombocytopenia (HIT), and immediately discontinued the heparin, implementing danaparoid (Orgaran) instead, following which the platelet count recovered. Heparin-induced thrombocytopenia, which causes thrombosis, is a serious side effect of heparin therapy and few cases of HIT associated with CPB surgery have been reported in Japan.
一名79岁男性因严重胸痛被转送至我院，疑似诊断为急性心肌梗死。急诊心脏导管检查显示三支血管冠状动脉疾病，我们在体外循环（CPB）下进行了冠状动脉搭桥术。术后因急性肾衰竭开始持续血液透析滤过，并给予肝素作为抗凝剂。肝素治疗开始9天后，他的血小板计数下降，左腿形成了深静脉血栓。我们怀疑是肝素诱导的血小板减少症（HIT），立即停用肝素，改用达那肝素（Orgaran），之后血小板计数恢复。肝素诱导的血小板减少症会导致血栓形成，是肝素治疗的严重副作用，在日本，与CPB手术相关的HIT病例报道较少。
