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目的应用血栓弹力图TEG评价小儿先天性心脏病术后凝血异常发生的流行病现况。方法依据先心病有无左向右或双向分流且血氧饱和度≤90%,将661例患儿分为紫绀组和非紫绀组,并按照年龄<1岁,1-3岁和≥3岁进行亚组分析。术后常规进行TEG检测比较主要参数之间的差异。结果先心病患儿术后凝血异常发生率高达46.3%,其中,血小板功能低下发生率43.7%占主要原因,其他凝血异常发生率如纤维蛋白原缺乏13%和凝血因子缺乏4.2%。与非紫绀组相比,紫绀患者术后凝血异常发生率63.4%显著高于非紫绀组39.7%,且凝血因子缺乏和纤维蛋白原缺乏均有显著差异,P<0.05。年龄亚组分析显示,<1岁患儿凝血异常风险相对于其他年龄组患儿增加,但紫绀患儿在1-3岁时纤维蛋白原功能和血小板功能低下发生率反而更高。结论先心病患儿心脏术后凝血异常发生率较高,其中血小板功能低下是主要原因。低龄和紫绀可能是术后凝血异常的高危风险因素,其次较大紫绀儿童的凝血风险也会相应增加。
Objective To evaluate the epidemiological status of coagulation abnormalities in pediatric patients with congenital heart disease by TGE. Methods According to whether there was left to right or bilateral shunt in patients with congenital heart disease and the blood oxygen saturation ≤90%, 661 children were divided into cyanosis group and non-cyanosis group according to the age <1 year old, 1-3 years old and ≥3 years old Subgroup analysis. TEG testing was routinely performed to compare the differences between the primary parameters. Results The incidence of abnormal coagulation in patients with congenital heart disease was as high as 46.3%. Among them, the incidence of platelet dysfunction was 43.7%, other coagulation abnormalities such as fibrinogen deficiency 13% and coagulation factor deficiency 4.2%. Compared with non-cyanotic group, the incidence of postoperative coagulation abnormalities in cyanotic patients was significantly higher 63.4% than non-cyanotic patients 39.7%, and lack of coagulation factors and fibrinogen were significantly different, P <0.05. Age-subgroup analyzes showed an increased risk of coagulopathy in children <1 year of age relative to children in other age groups, but the incidence of fibrinogen and platelet dysfunction in children with cyanosis was even higher at 1-3 years. Conclusion The incidence of abnormal cardiac coagulation in children with congenital heart disease is high, of which the main cause is the low platelet function. Older age and cyanosis may be high-risk risk factors for postoperative coagulation abnormalities, followed by larger cyanotic children’s blood clotting risk will be increased accordingly.