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心脏手术中的血小板减少症:诊断和预后的重要性。

Thrombocytopenia in cardiac surgery: diagnostic and prognostic importance.

作者信息

Rezende Ederlon, Morais Gustavo, Silva Junior João Manoel, Oliveira Amanda Maria Ribas Rosa de, Souza Jose Marconi Almeida, Toledo Diogo Oliveira, Richter Ivo, Brandão Enock Meira

机构信息

Intensive Care Service, State Civil Servant Hospital.

出版信息

Rev Bras Cir Cardiovasc. 2011 Jan-Mar;26(1):47-53. doi: 10.1590/s0102-76382011000100011.

Abstract

OBJECTIVE

Patients undergo to cardiac surgery have more probability to develop thrombocytopenia. The heparin induced thrombocytopenia happens in 5% of the patients. The aim from this study was to evaluate the clinical importance from the severe thrombocytopenia in postoperative cardiac surgical patients.

METHODS

It was included cardiac surgical patients with platelets < 150000 cel/mm³ during firsts 24 h from postoperative. All patients underwent evaluation for four Ts score (thrombocytopenia, use preview of heparin, thrombosis and platelets decreased not related to heparin). In order to a four Ts score e" 6 was considered as suggestive of heparin induced thrombocytopenia type II. The mortality rate in intensive care (ICU) and hospital, length of stay, healthy state and incidence from thrombosis were compared in patients with score > 6 (group 1) and < 6 (group 2).

RESULTS

It was include 120 patients who met the inclusions criterions. There was no difference between the groups in related to age, gender, time of cardiopulmonary bypass and surgery. However, the incidence of thrombosis was higher in group 1 (23% vs. 0%, P<0.0001), as well as the greater score is related to higher hospital mortality rate.

CONCLUSION

The score > 6, in postoperative cardiac surgical patients, it is associated to higher incidence of thrombosis as well as the greater score is related to higher hospital mortality rate.

摘要

目的

接受心脏手术的患者发生血小板减少症的可能性更高。肝素诱导的血小板减少症发生在5%的患者中。本研究的目的是评估心脏手术后严重血小板减少症的临床重要性。

方法

纳入术后最初24小时内血小板<150000个/立方毫米的心脏手术患者。所有患者均接受四项Ts评分(血小板减少、肝素使用情况、血栓形成和与肝素无关的血小板减少)评估。四项Ts评分≥6被认为提示II型肝素诱导的血小板减少症。比较评分>6(组1)和<6(组2)患者在重症监护病房(ICU)和医院的死亡率、住院时间、健康状况和血栓形成发生率。

结果

纳入120例符合纳入标准的患者。两组在年龄、性别、体外循环时间和手术时间方面无差异。然而,组1的血栓形成发生率更高(23%对0%,P<0.0001),且评分越高与医院死亡率越高相关。

结论

心脏手术后患者评分>6与血栓形成发生率较高相关,且评分越高与医院死亡率越高相关。

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