动脉导管未闭介入封堵术后血小板急剧减少三例浅论.docVIP

动脉导管未闭介入封堵术后血小板急剧减少三例 Three Cases Report about Platelet Decreased Sharply after the Interventional Closure of Patent Ductus Arteriosus 例1 患者男性，9岁，因劳力性气促9年入院。经超声心动图及X线胸片等检查诊断为动脉导管未闭（Patent ductus arteriosus，PDA）。 Case 1 A nine-year-old male patient was hospitalized because of exertional polypnea for nine years. he was diagnosed patent ductus arteriosus(PDA）by echocardiography and X-ray chest radiography examination . 入院后查血常规示：血小板为136.00×109/L，红细胞为4.60×1012/L，嗜酸性粒细胞计数为0.30×109/L。术中测肺动脉收缩压为90 mm Hg（1 mm Hg=0.133 kPa），舒张压为49 mm Hg，平均压为62 mm Hg。 After admission , checking routine blood showed: thrombocyte 136.00×109/L，erythrocyte 4.60×1012/L,eosinophilic granulocyte 0.30×109/L。during operation, the systolic pulmonary artery pressure was 90 mm Hg（1 mm Hg=0.133 kPa）diastolic blood pressure was 49 mm Hg, average pressure was 62 mm Hg. 造影示：巨大PDA（呈管状，最窄处直经为26 mm），主动脉弓降部直径为32 mm。因无相应大小的PDA封堵器，遂用32 mm房间隔封堵器试行封堵。封堵即刻，测肺动脉收缩压为52 mm Hg，舒张压为21 mm Hg，平均压力为31 mm Hg，但试封堵后数分钟，封堵伞即自行脱位，遂取出封堵器，终止手术。 在。。。的当时 Pulmonary and aorta angiography showed: giant PDA (tubular shape , diameter of the narrowest place is 26 mm) , the aortic arch descending segment diameter was 32 mm. Because there was no suitable size of PDA occluder , we tried to use interatrial septum defect occluder to closure the duct occluder. At the time of plugging , systolic pulmonary artery pressure was 52 mm Hg, diastolic blood pressure was 21 mmHg， the average pressure was 31 mm Hg， but a few minutes after the plugging, the duct occluder immediately fall off automatically. Then, we took the occluder out, and terminated the operation. 7 d后采用特制的32 mm PDA封堵伞（上海形状记忆合金材料公司）再次封堵成功，但术后即刻造影示：封堵器内可见明显的滤过血流。 Seven days later , we closured the PDA successfully by using specially made 32 mm duct occluder(Shanghai shape memory alloy materials company), but it could be seen that filtration blood flow ran through the duct occluder obviously by immediately postoperative angio