中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2009年
10期
1024-1026
,共3页
王永亮%张伟%万俊哲%李少民%裴斐%张军
王永亮%張偉%萬俊哲%李少民%裴斐%張軍
왕영량%장위%만준철%리소민%배비%장군
机械心脏瓣膜置换术%抗凝治疗%并发症
機械心髒瓣膜置換術%抗凝治療%併髮癥
궤계심장판막치환술%항응치료%병발증
Heart valve replacement%Anticoagulation therapy%Complications
目的 了解机械心脏瓣膜置换术后远期国际标准化比值(INR)与并发症的关系,最佳抗凝强度范围及临床意义.方法 对行机械心脏瓣膜置换术后出院6个月以上的患者在门诊检查凝血三项(PT、PT%、PTR、INR、Fbg、APTY)216例次.按照INR结果不同分为4组.Ⅰ组:INR<1.5;Ⅱ组:INR 1.5～2.0;Ⅲ组:INR 2.1～2.5;Ⅳ组:INR>2.5.结果 Ⅰ组28例次,华法林服用量(3.61±1.44)mg,INR(1.38±0.12),出现脑栓塞4例次,并发症发生率14%;Ⅱ组92例次,华法林服用量(3.50±1.37)mg,INR(1.65±0.14),出现鼻出血2例次,并发症发生率2%;Ⅲ组80例次,华法林服用量(3.18±1.63)mg,INR(2.23±0.19),出现血尿2例次,鼻出血2例次,并发症发生率5%;Ⅳ组16例次,华法林服用量(2.32±1.23)mg,INR(2.80±0.19),出现鼻出血2例次、咯血1例次,并发症发生率18.7%.Ⅱ、Ⅲ组的并发症占总数的79.6%,INR在1.5～2.5之间并发症最低.结论 INR在1.5～2.5之间是安全可靠的,是本地区最佳抗凝强度范围.机械心脏瓣膜置换术后抗凝强度是动态的,术后远期更应高度关注抗凝状态.
目的 瞭解機械心髒瓣膜置換術後遠期國際標準化比值(INR)與併髮癥的關繫,最佳抗凝彊度範圍及臨床意義.方法 對行機械心髒瓣膜置換術後齣院6箇月以上的患者在門診檢查凝血三項(PT、PT%、PTR、INR、Fbg、APTY)216例次.按照INR結果不同分為4組.Ⅰ組:INR<1.5;Ⅱ組:INR 1.5～2.0;Ⅲ組:INR 2.1～2.5;Ⅳ組:INR>2.5.結果 Ⅰ組28例次,華法林服用量(3.61±1.44)mg,INR(1.38±0.12),齣現腦栓塞4例次,併髮癥髮生率14%;Ⅱ組92例次,華法林服用量(3.50±1.37)mg,INR(1.65±0.14),齣現鼻齣血2例次,併髮癥髮生率2%;Ⅲ組80例次,華法林服用量(3.18±1.63)mg,INR(2.23±0.19),齣現血尿2例次,鼻齣血2例次,併髮癥髮生率5%;Ⅳ組16例次,華法林服用量(2.32±1.23)mg,INR(2.80±0.19),齣現鼻齣血2例次、咯血1例次,併髮癥髮生率18.7%.Ⅱ、Ⅲ組的併髮癥佔總數的79.6%,INR在1.5～2.5之間併髮癥最低.結論 INR在1.5～2.5之間是安全可靠的,是本地區最佳抗凝彊度範圍.機械心髒瓣膜置換術後抗凝彊度是動態的,術後遠期更應高度關註抗凝狀態.
목적 료해궤계심장판막치환술후원기국제표준화비치(INR)여병발증적관계,최가항응강도범위급림상의의.방법 대행궤계심장판막치환술후출원6개월이상적환자재문진검사응혈삼항(PT、PT%、PTR、INR、Fbg、APTY)216례차.안조INR결과불동분위4조.Ⅰ조:INR<1.5;Ⅱ조:INR 1.5～2.0;Ⅲ조:INR 2.1～2.5;Ⅳ조:INR>2.5.결과 Ⅰ조28례차,화법림복용량(3.61±1.44)mg,INR(1.38±0.12),출현뇌전새4례차,병발증발생솔14%;Ⅱ조92례차,화법림복용량(3.50±1.37)mg,INR(1.65±0.14),출현비출혈2례차,병발증발생솔2%;Ⅲ조80례차,화법림복용량(3.18±1.63)mg,INR(2.23±0.19),출현혈뇨2례차,비출혈2례차,병발증발생솔5%;Ⅳ조16례차,화법림복용량(2.32±1.23)mg,INR(2.80±0.19),출현비출혈2례차、각혈1례차,병발증발생솔18.7%.Ⅱ、Ⅲ조적병발증점총수적79.6%,INR재1.5～2.5지간병발증최저.결론 INR재1.5～2.5지간시안전가고적,시본지구최가항응강도범위.궤계심장판막치환술후항응강도시동태적,술후원기경응고도관주항응상태.
Objective To investigate the long-term anticoagulation starus and relation of INR and complica-tion,best anticoagulation range and clinical significance in patients after mechanical heart valve replacement. Meth-ods The data of blood clotting test series(containing PT,PT% ,PTR,INR,Fbg,APTT) for patients after 6 months of mechanical heart valve replacement were collected, then the cases were divided into 4 groups according to their INR levels( group Ⅰ : INR < 1.5; group Ⅱ : INR 1.5 ～ 2.0 ; group Ⅲ : INR 2.1 ～ 2.5 ; group Ⅳ : INR > 2.5 ). Results Group Ⅰ contained 28 person-times, with their dosage of warfarin for (3.61 ± 1.44 ) mg, INR 1.38 ± 0. 12, core-bral embolism occurred for 4 person-times,with a inception rate of 14%. Group Ⅱ contained 92 person-times,with their dosage of warfarin for (3.5±1.37)mg,INR 1.65±0. 14,hemorrhinia occurred for 2 person-times,with a in-ception rate of 2%. Group Ⅲ contained 80 person-times, with their dosage of warfarin for (3.18±1.63 )mg, INR 2.23±0.19 ,bematuria occurred for 2 person-times, bemorrhinia occurred for 2 person-times, with a total inception rate of 5% ; Group Ⅳ contained 16 person-times, with their dosage of warfarin for ( 2.32 ± 1. 23 ) mg, INR 2.80± 0.19, hemorrhinia occurred for 2 person-times and hemoptysis occurred for 1 person-times, with a total inception rate of 18.7%. The person-times in group Ⅱ and Ⅲ accounted for 79.6% and the complication rate was the lowest when INR was between 1.5-2.5. Conclusions INR levels between 1.5-2.5 is the most secure, which is the best antico-agu]ation range in our region. Since the anticoagulation strength dynamically changes, the long-term anticoagulation status in patients after mechanical heart valve replacement should be deeply concerned.
