小儿射频消融术肝素抵抗致股动脉血栓一例
Journal of Clinical Anesthesiology(2014)
Abstract
患儿,女,3岁4个月,体重14.3 kg,因室性早搏于全麻下行心脏电生理检查+射频消融术.患儿发育正常,无其他疾病史.术前检查:WBC 10.12×109/L,Plt 533×109/L,凝血酶原时间(PT) 11.1 s,部分凝血活酶时间(APTT)35 s,凝血酶时间(TT) 22 s,纤维蛋白原(FIB)2.56 g/L;肝肾功能及电解质正常.ECG示频发室早,心脏彩超未见明显异常.
入室后静脉推注舒芬太尼5μg、咪达唑仑1mg、丙泊酚60 mg诱导,置入2# Supreme喉罩,术中以2%七氟醚维持麻醉.经心脏电生理检查证明,室早起源位于左室中后间隔,需经右股动脉置入导管消融.穿刺动脉前常规静推肝素700U,每小时追加350 U.手术历时3.5h.术后常规压迫右股动脉0.5h,并监测同侧足部SpO2,以了解右股动脉是否通畅.压迫5 min即止血,右下肢皮肤发白,温度低于对侧,不能扪及右股动脉、右足背动脉,足部SpQ亦消失.可疑股动脉血栓形成,立即静推肝素350 U,5min后监测ACT 103 s.
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