腔靜脈-肺動脈連接術后圍術期血栓栓塞的治療與預防_《中國胸心血管外科臨床雜志》

作者：

中國醫學科學院北京協和醫學院?阜外心血管病醫院?小兒心臟外科中心，北京?100037;

關鍵詞：

腔靜脈-肺動脈連接術　雙向Glenn手術　全腔靜脈-肺動脈連接術　Fontan手術　血栓栓塞　肺栓塞

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目的　分析腔靜脈-肺動脈連接術后圍術期血栓栓塞的表現、治療、轉歸和可能危險因素，評估預防血栓栓塞措施的效果。　方法　回顧性分析2005年9月至2010年12月期間阜外心血管病醫院完成雙向Glenn手術264例、全腔靜脈-肺動脈連接術（total cavopulmonary connection，TCPC） 224例患者的臨床資料，其中圍術期發生血栓栓塞9例，男5例，女4例；年齡0.9～11.0 （5.1±3.7）歲；體重8～30 （17±8） kg 。5例為雙向Glenn手術，4例為TCPC。多數栓塞患者合并至少一個血栓高危因素。術后常規靜脈泵入預防量肝素10 U/?（kg·h），續以口服阿司匹林1～3 mg/?（kg·d）預防血栓。　結果　9例中 6例血栓栓塞發生于術后7 d之內，3例發生在術后2～4周。9例均給予肝素抗凝治療，其中1例行下腔靜脈-右心房連接術。死亡3例（33%），分別占同期雙向Glenn手術和TCPC 后早期死亡的33% （1/3）和18% （2/11）；其余6例癥狀和體征改善或消失。　結論　腔靜脈-肺動脈連接術后圍術期血栓栓塞的病死率高，是此類手術術后早期死亡的重要原因。圍術期預防血栓的策略有效，但仍需注意避免一些相關危險因素。

引用本文： 凌雁,郭少先,沈向東,閆軍,李守軍. 腔靜脈-肺動脈連接術后圍術期血栓栓塞的治療與預防. 中國胸心血管外科臨床雜志, 2012, 19(4): 358-361. doi: 復制

1.	occluded cavopulmonary connections in infants and children. Interact Cardiovasc Thorac Surg, 2010, 10 （3）：383-388.
2.	Hedrick M, Elkins RC, Knott-Craig CJ, et al. Successful thrombectomy for thrombosis of the right side of the heart after the Fontan operation. Report of two cases and review of the literature. J Thorac Cardiovasc Surg, 1993, 105 （2）：297-301.
3.	Jahangiri M, Shore D, Kakkar V, et al. Coagulation factor abnormalities after the Fontan procedure and its modifications. J Thorac Cardiovasc Surg, 1997, 113 （6）：989-992.
4.	Shirai LK, Rosenthal DN, Reitz BA, et al. Arrhythmias and thromboembolic complications after the extracardiac Fontan operation. J Thorac Cardiovasc Surg, 1998, 115 （3）：499-505.
5.	Monagle P, Cochrane A, McCrindle, et al. Thromboembolic complications after Fontan procedures-the role of prophylactic anticoagulation. J Thorac Cardiovasc Surg, 1998, 115 （3）：493-498.
6.	Coon PD, Rychik J, Novello RT, et al. Thrombus formation after the Fontan operation. Ann Thorac Surg, 2001, 71 （6）：1990-1994.
7.	Ravn HB, Hjortdal VE, Stenbog EV, et al. Increased platelet reactivity and significant changes in coagulation markers after cavopulmonary connection. Heart, 2001, 85 （1）：61-65.
8.	Jacobs ML, Pourmoghadam KK, Geary EM, et al. Fontan’s operation： is aspirin enough? Is coumadin too much? Ann Thorac Surg, 2002, 73 （1）：64-68.
9.	Odegard KC, McGowan FX, Zurakowski D, et al. Procoagulant and anticoagulant factor abnormalities following the Fontan procedure：　increased factor VIII may predispose to thrombosis. J Thorac　Cardiovasc Surg, 2003, 125 （6）：1260-1267.
10.	Gupta A, Daggett C, Behera S, et al. Risk factors for persistent pleural effusions after the extracardiac Fontan procedure. J Thorac　Cardiovasc Surg, 2004, 127 （6）：1664-1669.
11.	Van den Bosch AE, Roos-Hesselink JW, Van Domberg, et al. Long-term outcome and quality of life in adult patients after the Fontan operation. Am J Cardiol, 2004, 93 （9）：1141-1145.
12.	Kaulitz R, Ziemer G, Rauch R, et al. Prophylaxis of thromboembolic complications after the Fontan operation （total cavopulmonary anastomosis）. J Thorac Cardiovasc Surg, 2005, 129 （3）：569-575.
13.	Bartz PJ, Driscoll DJ, Dearani JA, et al. Early and late results of the modified Fontan operation for heterotaxy syndrome 30 years of experience in 142 patients. J Am Coll Cardiol, 2006, 48 （11）：2301-2305.
14.	d’Udekem Y, Iyengar AJ, Cochrane AD, et al. the Fontan procedure：　contemporary techniques have improved long-term outcomes.　Circulation, 2007, 116 （suppl 1）：I157-I164.
15.	Khairy P, Fernandes SM, Mayer JE Jr, et al. Long-term survival, modes of death, and predictors of mortality in patients with Fontan surgery. Circulation, 2008, 117 （1）：85-92.
16.	Jacobs ML, Pelletier GJ, Pourmoghadam KK, et al. Protocols associated with no mortality in 100 consecutive Fontan procedures. Eur J Cardiothorac Surg, 2008, 33 （4）：626-632.
17.	Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the　diagnosis and management of acute pulmonary embolism. Eur Heart J, 2008, 29 （18）：2276-2315.
18.	Tapson VF. Acute pulmonary embolism. N Engl J Med, 2008, 358 （10）：1037-1052.
19.	Monagle P, Chalmers E, Chan A, et al. Antithrombotic therapy in　neonates and children. American college of chest physicians evidence-based clinical practice guidelines （8th edition）. Chest, 2008, 133 （6）：887S-968S.
20.	Sreeram N, Emmel M, Trieschmann U, et al. Reopening acutely.
21.	Massicotte P, Julian JA, Gent M, et al. An open-label randomized controlled trial of low molecular weight heparin for the prevention of central venous line-related thrombotic complications in children： the PROTEKT trial. Thromb Res, 2003, 109 （2-3）：101-108.
22.	Hanslik A, Thom K, Haumer M, et al. Incidence and diagnosis of thrombosis in children with short-term central venous lines of the　upper venous system. Pediatrics, 2008, 122 （6）：1284-1291.

1. occluded cavopulmonary connections in infants and children. Interact Cardiovasc Thorac Surg, 2010, 10 （3）：383-388.
2. 　Hedrick M, Elkins RC, Knott-Craig CJ, et al. Successful thrombectomy for thrombosis of the right side of the heart after the Fontan operation. Report of two cases and review of the literature. J Thorac Cardiovasc Surg, 1993, 105 （2）：297-301.
3. 　Jahangiri M, Shore D, Kakkar V, et al. Coagulation factor abnormalities after the Fontan procedure and its modifications. J Thorac Cardiovasc Surg, 1997, 113 （6）：989-992.
4. 　Shirai LK, Rosenthal DN, Reitz BA, et al. Arrhythmias and thromboembolic complications after the extracardiac Fontan operation. J Thorac Cardiovasc Surg, 1998, 115 （3）：499-505.
5. 　Monagle P, Cochrane A, McCrindle, et al. Thromboembolic complications after Fontan procedures-the role of prophylactic anticoagulation. J Thorac Cardiovasc Surg, 1998, 115 （3）：493-498.
6. 　Coon PD, Rychik J, Novello RT, et al. Thrombus formation after the Fontan operation. Ann Thorac Surg, 2001, 71 （6）：1990-1994.
7. 　Ravn HB, Hjortdal VE, Stenbog EV, et al. Increased platelet reactivity and significant changes in coagulation markers after cavopulmonary connection. Heart, 2001, 85 （1）：61-65.
8. 　Jacobs ML, Pourmoghadam KK, Geary EM, et al. Fontan’s operation： is aspirin enough? Is coumadin too much? Ann Thorac Surg, 2002, 73 （1）：64-68.
9. 　Odegard KC, McGowan FX, Zurakowski D, et al. Procoagulant and anticoagulant factor abnormalities following the Fontan procedure：　increased factor VIII may predispose to thrombosis. J Thorac　Cardiovasc Surg, 2003, 125 （6）：1260-1267.
10. 　Gupta A, Daggett C, Behera S, et al. Risk factors for persistent pleural effusions after the extracardiac Fontan procedure. J Thorac　Cardiovasc Surg, 2004, 127 （6）：1664-1669.
11. 　Van den Bosch AE, Roos-Hesselink JW, Van Domberg, et al. Long-term outcome and quality of life in adult patients after the Fontan operation. Am J Cardiol, 2004, 93 （9）：1141-1145.
12. 　Kaulitz R, Ziemer G, Rauch R, et al. Prophylaxis of thromboembolic complications after the Fontan operation （total cavopulmonary anastomosis）. J Thorac Cardiovasc Surg, 2005, 129 （3）：569-575.
13. 　Bartz PJ, Driscoll DJ, Dearani JA, et al. Early and late results of the modified Fontan operation for heterotaxy syndrome 30 years of experience in 142 patients. J Am Coll Cardiol, 2006, 48 （11）：2301-2305.
14. 　d’Udekem Y, Iyengar AJ, Cochrane AD, et al. the Fontan procedure：　contemporary techniques have improved long-term outcomes.　Circulation, 2007, 116 （suppl 1）：I157-I164.
15. 　Khairy P, Fernandes SM, Mayer JE Jr, et al. Long-term survival, modes of death, and predictors of mortality in patients with Fontan surgery. Circulation, 2008, 117 （1）：85-92.
16. 　Jacobs ML, Pelletier GJ, Pourmoghadam KK, et al. Protocols associated with no mortality in 100 consecutive Fontan procedures. Eur J Cardiothorac Surg, 2008, 33 （4）：626-632.
17. 　Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the　diagnosis and management of acute pulmonary embolism. Eur Heart J, 2008, 29 （18）：2276-2315.
18. 　Tapson VF. Acute pulmonary embolism. N Engl J Med, 2008, 358 （10）：1037-1052.
19. 　Monagle P, Chalmers E, Chan A, et al. Antithrombotic therapy in　neonates and children. American college of chest physicians evidence-based clinical practice guidelines （8th edition）. Chest, 2008, 133 （6）：887S-968S.
20. 　Sreeram N, Emmel M, Trieschmann U, et al. Reopening acutely.
21. 　Massicotte P, Julian JA, Gent M, et al. An open-label randomized controlled trial of low molecular weight heparin for the prevention of central venous line-related thrombotic complications in children： the PROTEKT trial. Thromb Res, 2003, 109 （2-3）：101-108.
22. 　Hanslik A, Thom K, Haumer M, et al. Incidence and diagnosis of thrombosis in children with short-term central venous lines of the　upper venous system. Pediatrics, 2008, 122 （6）：1284-1291.

《中國胸心血管外科臨床雜志》

腔靜脈-肺動脈連接術后圍術期血栓栓塞的治療與預防

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《中國胸心血管外科臨床雜志》

腔靜脈-肺動脈連接術后圍術期血栓栓塞的治療與預防

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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