| Objective:Congenital heart disease(CHD)is the most common human birth defect,and most children with CHD need to be performed intracardiac direct-view correct surgery assisted by cardiopulmonary bypass(CPB).CPB affects the inherent balance between bleeding and coagulation in the body,which increases the risk of postoperative bleeding and thrombosis.This study focused on the effect of early heparin anticoagulation therapy on coagulation tests after CPB in young infants with CHD and low weight.Methods:Data were retrospectively collected from December 2019 to December 2021 from children with CHD treated by CPB-assisted intracardiac surgery in the Department of Cardiothoracic Surgery of Shanxi Children’s Hospital.They were divided into heparintreated group and non-heparin group,and the coagulation function laboratory results of children in both groups were collected for several periods to observe the trend of coagulation index D-dimer in heparin-treated group and non-heparin group and the difference between the two groups.Results:1.General information of the children included in the studyA total of 102 children aged <1 year were collected.54 patients in the low-dose heparin treatment group(observation group)were aged 1-272d(119.81±66.90d)and weighed 3.0-8.1kg(5.41±1.08kg).The operation time was 126-420min(216.56±66.91min).The CPB time was 47-256min(127.57±51.80 min),and the aorta occlusion time was 15-191min(81.67±38.85 min).48 patients in the non-heparin group(control group),aged 23～312d(138.00±67.67d),weight 3.1～8.7kg(5.65±1.31kg),operation time 112～306min(196.81± 49.34min),CPB time was 55-235min(116.59±42.00 min),aorta occlusion time was 26-168min(71.04±27.69 min).There were no significant differences in gender,age,body weight and operation time between the two groups(p>0.05).2.Results of the intergroup analysis between the observation group and the control groupThere was no statistically significant difference in the distribution of D-dimer between the observation group and the control group before surgery,after surgery(admission to cardiac care units after surgery),and before medication(p>0.05);24hours after medication,the D-dimer in the observation group was significantly lower than that in the control group,and the difference was statistically significant(z=-2.212,p<0.05);the amount of change in D-dimer between the post-medication and premedication was statistically significant between the observation group and the control group(z=-2.169,p<0.05).3.Results of intra-group analysis in the observation groupThere was a statistically significant difference between the postoperative period(postoperative admission to cardiac care units)and the preoperative period,as well as between the postoperative admission to cardiac care units and the next postoperative day,when the D-dimer was consistently elevated(p<0.05);the difference between the post-medication and pre-medication was not statistically significant(z=-0.331,p>0.05);the difference between the postoperative period and the post-medication was statistically significant(z=-3.405,p <0.05).The difference in D-dimer was statistically significant(Z=-3.059,p<0.05)at 24 h after heparin administration compared with that before surgery,still higher than that before surgery.4.Results of intra-group analysis in the control groupIn the control group,D-dimer was consistently elevated from the preoperative period to 24 hours after mediation,and the differences in D-dimer were statistically significant when compared with each other at all periods(p<0.05 for all)Conclusions:Early anticoagulation therapy with low-dose heparin after CHD procedure assisted by cardiopulmonary bypass can alleviate CPB-induced coagulation abnormalities and had a significant protective effect on preventing postoperative thrombosis and even DIC,providing a new clinical evidence for postoperative anticoagulation therapy in young infants with congenital heart disease and low weight. |
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