中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
19期
8720-8724
,共5页
孙家兴%胡海燕%陈丽丽%林存智
孫傢興%鬍海燕%陳麗麗%林存智
손가흥%호해연%진려려%림존지
血小板减少%肺栓塞%肝素诱导%磺达肝癸钠
血小闆減少%肺栓塞%肝素誘導%磺達肝癸鈉
혈소판감소%폐전새%간소유도%광체간계납
Thrombocytopenia%Pulmonary embolism%Heparin-induced%Fondaparinux
目的：提高对肝素诱导的肺栓塞患者血小板减少（HIT）的认识及规范诊治。方法报道1例2012年10月肺栓塞患者肝素抗凝治疗7 d后出现血小板减少的临床资料、诊疗经过及预后过程，并进行文献复习及指南解读。以“肝素诱导的血小板减少，肺栓塞，磺达肝癸钠”为检索词，通过万方医学数据库对中文文献进行检索；以“Heparin-induced thrombocytopenia，pulmonary embolism，fondaparinux”为检索词，通过PubMed数据库进行检索，检索时间截止2013年7月。根据2012美国胸内科医师协会（ACCP）关于肝素诱导的血小板减少症的诊治指南提出规范治疗。结果患者女，41岁，因胸闷、憋气1个月，加重3 d入院。肺动脉造影（CTPA）诊断为双肺动脉栓塞，给予阿替普酶溶栓，后持续普通肝素静脉泵入抗凝治疗，抗凝治疗第7天出现血小板减少，最低17×109/L，停用肝素改为磺达肝癸钠皮下注射，血小板升至251×109/L停用磺达肝癸钠，口服华法林治疗，出院后门诊随访6个月，患者病情平稳。在万方医学数据库未检索到应用肝素治疗肺栓塞抗凝过程中并发 HIT 后改用磺达肝癸钠治疗的报道；PubMed 数据库检索到8篇治疗肺栓塞抗凝过程中并发HIT后应用磺达肝癸钠的个案报道。结论肺栓塞患者应用肝素抗凝治疗可以出现无症状的HIT，应注意监测血小板，改用磺达肝葵钠可以预防HIT的发生。
目的：提高對肝素誘導的肺栓塞患者血小闆減少（HIT）的認識及規範診治。方法報道1例2012年10月肺栓塞患者肝素抗凝治療7 d後齣現血小闆減少的臨床資料、診療經過及預後過程，併進行文獻複習及指南解讀。以“肝素誘導的血小闆減少，肺栓塞，磺達肝癸鈉”為檢索詞，通過萬方醫學數據庫對中文文獻進行檢索；以“Heparin-induced thrombocytopenia，pulmonary embolism，fondaparinux”為檢索詞，通過PubMed數據庫進行檢索，檢索時間截止2013年7月。根據2012美國胸內科醫師協會（ACCP）關于肝素誘導的血小闆減少癥的診治指南提齣規範治療。結果患者女，41歲，因胸悶、憋氣1箇月，加重3 d入院。肺動脈造影（CTPA）診斷為雙肺動脈栓塞，給予阿替普酶溶栓，後持續普通肝素靜脈泵入抗凝治療，抗凝治療第7天齣現血小闆減少，最低17×109/L，停用肝素改為磺達肝癸鈉皮下註射，血小闆升至251×109/L停用磺達肝癸鈉，口服華法林治療，齣院後門診隨訪6箇月，患者病情平穩。在萬方醫學數據庫未檢索到應用肝素治療肺栓塞抗凝過程中併髮 HIT 後改用磺達肝癸鈉治療的報道；PubMed 數據庫檢索到8篇治療肺栓塞抗凝過程中併髮HIT後應用磺達肝癸鈉的箇案報道。結論肺栓塞患者應用肝素抗凝治療可以齣現無癥狀的HIT，應註意鑑測血小闆，改用磺達肝葵鈉可以預防HIT的髮生。
목적：제고대간소유도적폐전새환자혈소판감소（HIT）적인식급규범진치。방법보도1례2012년10월폐전새환자간소항응치료7 d후출현혈소판감소적림상자료、진료경과급예후과정，병진행문헌복습급지남해독。이“간소유도적혈소판감소，폐전새，광체간계납”위검색사，통과만방의학수거고대중문문헌진행검색；이“Heparin-induced thrombocytopenia，pulmonary embolism，fondaparinux”위검색사，통과PubMed수거고진행검색，검색시간절지2013년7월。근거2012미국흉내과의사협회（ACCP）관우간소유도적혈소판감소증적진치지남제출규범치료。결과환자녀，41세，인흉민、별기1개월，가중3 d입원。폐동맥조영（CTPA）진단위쌍폐동맥전새，급여아체보매용전，후지속보통간소정맥빙입항응치료，항응치료제7천출현혈소판감소，최저17×109/L，정용간소개위광체간계납피하주사，혈소판승지251×109/L정용광체간계납，구복화법림치료，출원후문진수방6개월，환자병정평은。재만방의학수거고미검색도응용간소치료폐전새항응과정중병발 HIT 후개용광체간계납치료적보도；PubMed 수거고검색도8편치료폐전새항응과정중병발HIT후응용광체간계납적개안보도。결론폐전새환자응용간소항응치료가이출현무증상적HIT，응주의감측혈소판，개용광체간규납가이예방HIT적발생。
Objective To improve the understanding of heparin-induced thrombocytopenia(HIT). Methods A case of HIT diagnosed in July 2012 was reported, and the related literatures were reviewed.After learning the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines published on Chest 2012, we present an idea of the treatment and prevention of HIT. Results A case of 41 years-old female patient, who was admitted to the hospital because of Chest tightness of breath for 1 month, which acute exacerbation for 3 days. She was diagnosed with pulmonary embolism by Computed Tomography Pulmonary Angiography. We used the Intravenous heparin after thrombolytic therapy. We found the thrombocytopenia at the 7th day after initiation of heparin.We diagnosed as HIT and stopped using the heparin, meanwhile, we started anticoagulant therapy by fondaparinux. The case was received by fondaparinux for 14 days until the clinical symptoms disappear and the platelets have substantially recovered normal(about 251×109/L). No literature was received in Wanfang Med Online.According to our knowledge this is first report of fondaparinux usage in pulmonary embolism patient with HIT in China.Eight literatures were received in PubMed, including Surgical and medical patients with pulmonary embolism reports. Conclusions HIT is an antibody-mediated adverse drug reaction happened in 5 to 10 days after initiation of heparin that can lead to devastating thromboembolic complications, including pulmonary embolism, ischemic limb necrosis necessitating limb amputation, acute myocardial infarction, and stroke. For patients receiving heparin in whom clinicians consider the high risk of HIT, we suggest that platelet count monitoring be performed in order to prevention of HIT.
