中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2009年
11期
889-891
,共3页
肝素%低分子量%心脏瓣膜%人工%华法林
肝素%低分子量%心髒瓣膜%人工%華法林
간소%저분자량%심장판막%인공%화법림
Heparin,low-molecular-weight%Heart valve prosthesis%Warfarin
目的 探讨人工心脏瓣膜置换术后的患者行腹部手术时围手术期停用华法林后使用低分子肝素桥接抗凝的安全性.方法 回顾性研究2002年1月至2009年4月期间收治的人工心脏瓣膜置换术后需要行腹部手术的患者70例,术前3 d开始停用华法林,术后36 h恢复华法林口服,如果术前凝血酶原时间国际标准化比值(international normalization ratio,INB)>1.5则使用维生素K1对抗华法林,使之终止抗凝作用.停用华法林后,患者中前33例使用低分子肝素桥接围手术期(桥接组),后37例不用抗凝药物进行桥接(非桥接组).对比研究两组患者术后出血及发生血栓并发症的风险.结果 桥接组术后伤口出血2例,非桥接组无术后伤口出血,两组差异无统计学意义(χ~2=0.641,P>0.05).两组住院期间均无瓣膜血栓形成.结论 人工心脏瓣膜置换术后患者行腹部手术时围手术期停用华法林后使用低分子肝素桥接抗凝是一种安全的方法,未增加出血的风险,在理论上降低了瓣膜血栓形成的风险,并且使围手术期抗凝处理更加灵活安全.
目的 探討人工心髒瓣膜置換術後的患者行腹部手術時圍手術期停用華法林後使用低分子肝素橋接抗凝的安全性.方法 迴顧性研究2002年1月至2009年4月期間收治的人工心髒瓣膜置換術後需要行腹部手術的患者70例,術前3 d開始停用華法林,術後36 h恢複華法林口服,如果術前凝血酶原時間國際標準化比值(international normalization ratio,INB)>1.5則使用維生素K1對抗華法林,使之終止抗凝作用.停用華法林後,患者中前33例使用低分子肝素橋接圍手術期(橋接組),後37例不用抗凝藥物進行橋接(非橋接組).對比研究兩組患者術後齣血及髮生血栓併髮癥的風險.結果 橋接組術後傷口齣血2例,非橋接組無術後傷口齣血,兩組差異無統計學意義(χ~2=0.641,P>0.05).兩組住院期間均無瓣膜血栓形成.結論 人工心髒瓣膜置換術後患者行腹部手術時圍手術期停用華法林後使用低分子肝素橋接抗凝是一種安全的方法,未增加齣血的風險,在理論上降低瞭瓣膜血栓形成的風險,併且使圍手術期抗凝處理更加靈活安全.
목적 탐토인공심장판막치환술후적환자행복부수술시위수술기정용화법림후사용저분자간소교접항응적안전성.방법 회고성연구2002년1월지2009년4월기간수치적인공심장판막치환술후수요행복부수술적환자70례,술전3 d개시정용화법림,술후36 h회복화법림구복,여과술전응혈매원시간국제표준화비치(international normalization ratio,INB)>1.5칙사용유생소K1대항화법림,사지종지항응작용.정용화법림후,환자중전33례사용저분자간소교접위수술기(교접조),후37례불용항응약물진행교접(비교접조).대비연구량조환자술후출혈급발생혈전병발증적풍험.결과 교접조술후상구출혈2례,비교접조무술후상구출혈,량조차이무통계학의의(χ~2=0.641,P>0.05).량조주원기간균무판막혈전형성.결론 인공심장판막치환술후환자행복부수술시위수술기정용화법림후사용저분자간소교접항응시일충안전적방법,미증가출혈적풍험,재이론상강저료판막혈전형성적풍험,병차사위수술기항응처리경가령활안전.
Objective To explore the safety and effectiveness of using low molecular weight heparin (LMWH) in place of warfarin for anticoagulation in patients with a previous cardiac valve replacement. Methods We reviewed 70 patients hospitalized from Jan 2002 to Apr 2009 undergoing abdominal surgery who have had a previous cardiac valve replacement and had been on warfarin anticoagulation therapy. LMWH began to replace warfarin for anticoagulation 3 clay before the surgery in 33 cases, while the other 37 patients simply ceased to use any anticoagulant since 3 days before the surgery. Postoperative bleeding and embolism risk were compared between these two groups. Results There were 2 patients suffering from postoperative bleeding in the operative field in LMWH group, while there was no postoperative bleeding in patients on anticoagulant suspension group (χ~2=0.641, P>0.05). There was no valve embolism occurred in these two groups. Conclusions It is a safe way to stop using warfarin with LMWH taking the task for perioperative anticoagulation in patients with a history of cardiac valve replacement 3 days before an elective abdominal surgery. This protocol decreases the risk rate of valve embolism not at the expense of increasing postoperative bleeding.
