接受心臟手術的真性紅血球增多症患者圍手術期凝血障礙性併發症

Perioperative Coagulopathies in Polycythemia Vera Patients Undergoing Heart Operations

心臟手術的真性紅血球增多症患者易發生圍手術期凝血障礙性併發症。本研究的目的是總結圍手術期凝血障礙性併發症的特點、處理和預後。研究材料基於對1980年以來發表的相關文章的綜合文獻檢索。結果顯示共有15篇文章，17名患者被納入本研究。患者被分為事件組和非事件組。事件組的患者年齡明顯大於非事件組。事件組的8名（100%）患者和非事件組的7名（77.8%）患者均為高危患者。手術適應症為14例（82.4%）原發性心血管疾病，3例（17.6%）繼發於真性紅血球增多症的併發症。該患者序列的死亡率為11.8%。與非事件組相比，事件組的康復率較低，死亡率較高。接受心臟手術的真性紅血球增多症患者圍手術期併發症的風險增加。血栓併發症除了涉及心臟和大血管外，還涉及人工心臟瓣膜、冠狀動脈繞道血管、體外循環管路。體外循環管路血栓形成和對啟動凝血時間和氧合器穿膜壓力梯度的不利影響是心臟手術實施的重大障礙。有必要在術前和術中採取預防措施，降低紅血球比容，以最大限度地降低風險，改善患者的預後。高危患者需要持續的術後治療。

Patients with polycythemia vera are predisposed to perioperative coagulopathic complications during heart operations. The aim of the present study was to summarize the characteristics, management and prognosis of perioperative coagulopathies. The study materials were based on comprehensive literature retrieval of the relevant articles published since 1980. A total of 15 articles with 17 patients were recruited into this study. Patients were divided into Event (n = 8) and Non-Event (n = 9) groups. Patients were significantly older in the Event Group than in the Non-Event Group. All 8 (100%) patients of the Event Group and 7 (77.8%) patients of the Non-Event Group were high-risk patients. The surgical indications were primary cardiovascular disease in 14 (82.4%) patients and there were complications secondary to polycythemia vera in 3 (17.6%) patients. The mortality rate of this patient cohort was 11.8%. The recovery rate of the Event Group was lower, and the mortality rate was higher when compared with the Non-Event Group. Patients with polycythemia vera undergoing a heart operation are at an increased risk of perioperative complications. The thrombotic complications can involve heart valve prosthesis, the coronary artery, and bypass graft and bypass circuit, in addition to heart and great vessels. Bypass circuit thrombosis and adverse effects on the activated clotting time and trans-oxygenator pressure gradient constitute a significant obstacle to the implementation of heart operations. It is necessary to take pre- and intraoperative prophylactic measures to decrease hematocrit, minimize the risks and improve patients’prognosis. Sustained postoperative treatment is necessary in high-risk patients.