Cardiopulmonary bypass-induced coagulopathy in pediatric patients: The role of platelets in postoperative bleeding. A preliminary study
Cardiopulmonary bypass-induced coagulopathy in pediatric patients: The role of platelets in postoperative bleeding. A preliminary study
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DOI：
10.1111/aor.13912
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发表时间：
2021-02-13
影响因子：
2.4
通讯作者：
Navalesi, Paolo
中科院分区：
文献类型：
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作者：
Di Gregorio, Guido;Sella, Nicolo;Navalesi, Paolo
儿科患者特别容易发生心肺转流（CPB）诱导的凝血功能障碍，主要是由于血液稀释、凝血因子消耗和体温过低。本研究的目的是检查血小板计数和功能的可能作用，因为它与儿科人群CPB后的出血风险有关。所有连续患者（年龄第75百分位数）均为出血者（例）。对照组为非出血者。共入组31例患者[中位年龄17（4-57）个月]。术后血小板计数显著降低（P <0.001），在ADP测试中，（P < .001），TRAP检验（P < .001）和ASPI检验（P < .001），术后24小时内胸管引流量与术后血小板计数受损呈正相关（R = 0.553，P = .001）、ADP检验（R = 0.543，P = .001）、TRAP检验（R = 0.627，P < .001）和ASI检验（R = 0.436，P = .014）。8名儿童（26%）发生了术后大出血。出血者明显更年轻（P = 0.015），CPB持续时间更长（P = 0.015）。尽管病例组和对照组的术后血小板计数和功能无显著差异，但出血者的血小板计数（P = .002）和ADP试验（P = .007）、TRAP试验（P = .020）和ASI试验（P = .042）的功能的术后减少（Delta）显著大于非出血者。Delta PLT >262 500 x10（9）/L，Delta ADP-测试>29 U，Delta TRAP-测试>44 U和Delta ASI-测试>26 U显示可预测术后大出血。接受CPB心脏手术的儿童术后出血与年龄较小、CPB持续时间较长以及术后血小板计数和功能显著降低有关。需要更大规模的研究来证实我们的结果，并确定减少这些患者术后出血的策略。
Pediatric patients are particularly prone to cardiopulmonary bypass (CPB)-induced coagulopathy mainly due to hemodilution, consumption of coagulation factors and hypothermia. The aim of the present study was to examine the possible role of platelet count and function as it relates to the bleeding risk after CPB in the pediatric population. All consecutive patients (age 75th percentile were bleeders (cases). Controls were nonbleeders. A total of 31 patients were enrolled [median age 17 (4-57) months]. A significant postoperative reduction in platelet count (P < .001) and function either in ADP-test (P < .001), TRAP-test (P < .001) and ASPI-test (P < .001) was found, with positive correlations between chest tube output within the first 24 hours after surgery and postoperative impairment of platelet count (R = 0.553, P = .001), ADP-test (R = 0.543, P = .001), TRAP-test (R = 0.627, P < .001) and ASPI-test (R = 0.436, P = .014). Eight children (26%) experienced major postoperative bleeding. Bleeders were significantly younger (P = .015) and underwent longer CPB duration (P = .015). Despite no significant differences in postoperative platelet count and function between cases and controls, the postoperative reduction (Delta) in platelet count (P = .002) and function in ADP-test (P = .007), TRAP-test (P = .020) and ASPI-test (P = .042) was significantly greater in bleeders vs. nonbleeders. A Delta PLT >262 500 x10(9)/L, a Delta ADP-test >29 U, a Delta TRAP-test >44 U and a Delta ASPI-test >26 U showed to be predictive of major postoperative bleeding. Postoperative bleeding in children undergoing cardiac surgery with CPB was linked to younger age, longer CPB duration, and significant postoperative reduction in platelet count and function. Larger studies are needed to confirm our results and define strategies to reduce postoperative bleeding in these patients.