先天性心脏病患儿Fontan手术围术期抗肝素血小板因子4抗体的变化及其影响因素

目的 研究先天性心脏病(先心病)患儿Fontan手术围术期抗肝素血小板因子4(PF4)抗体的变化规律及其影响因素.方法 随机选取Fontan手术患儿98例,美国麻醉医师学会(ASA)分级Ⅱ～Ⅲ级.所有患儿于开胸手术前、术后第5、l0天分别采集股静脉血lml,应用双抗原夹心法测定标本中人血小板第4因子IgG抗体水平.分别在术前和术后第1、3、5、7、10天检测患儿血小板计数.结果 术后第5天Fontan手术患儿存活93例,抗肝素PF4抗体lgG阳性率为33.3％(31例);术后第10天Fontan手术患儿存活91例,抗体IgG阳性率为41.8％(38例).98例先心病患儿中有4例(4.1％)发生肝素诱导性血小板减少症,其中肝素诱导性血小板减少症伴血栓形成3例.结论 先心病Fontan手术患儿因手术次数和术前心导管检查等因素增加与肝素接触的机会,会影响术后抗肝素PF4抗体IgG血清转化率.

The incidence and implications of anti-heparin platelet factor 4 antibodies in children with congenital heart disease undergoing Fontan surgery

Objective To investigate changes of perioperative anti-heparin platelet factor 4 （PF4） antibod- ies in children with congenital heart disease following Fontan surgery. Methods Ninety-eight patients with Ameri- can Society of Anesthesiologists （ASA） classification grade Ⅱ- Ⅲ were included in this study. Preoperative and postoperative day 5 and 10 femoral venous blood samples were used to determine the presence of anti-heparin PF4 antibodies with enzyme-linked immunosorbent assay. Platelet counts were measured preoperatively and on postopera- tive day （POD） 1, POD 3,POD 5,POD 7 and POD 10. Results On POD 5, anti-heparin PF4 antibody IgG was present in 31 of 93 patients （33.3%）. On POD 10 anti-heparin PF4 antibody IgG was present in 38 of 91 patients （41.8%）. Postoperatively, four patients developed thrombocytopenia and three patients manifested thrombosis. Conclusion Both number of cardiac surgery and previous catheterization history correlate with the rate of anti-hepa- rin/PF4 antibody seroconversion due to prior unfractionated heparin.