中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
8期
8-10
,共3页
心脏瓣膜%华法林%血栓前蛋白%D-二聚体
心髒瓣膜%華法林%血栓前蛋白%D-二聚體
심장판막%화법림%혈전전단백%D-이취체
Heart valves%Warfarin%Thrombus precursor protein%D-dimer
目的 探讨瓣膜置换术后华法林的最佳安全用量.方法 选择100例机械瓣膜置换术后患者,按不同体质量分为≤60 kg组(47例)与＞60 kg组(53例);按不同术后时间分为术后≤3个月组(39例)及术后＞3个月组(61例);按不同国际标准化比值(INR)分组,INR＜ 1.5为Ⅰ组(23例);INR 1.5～2.5为Ⅱ组(66例);INR＞ 2.5为Ⅲ组(11例).比较各组华法林用量,血浆血栓前蛋白(TpP)、D-二聚体(D-D)水平.结果 ≤60 kg组华法林用量为(2.90±1.11) mg,高于＞60kg组的(2.47±0.18) mg,差异有统计学意义(P＜0.05).术后≤3个月组与术后＞3个月组华法林用量比较差异无统计学意义(P＞0.05),两组TpP及D-D比较差异有统计学意义[(6.32±0.01) mg/L比(4.97±0.81) mg/L、(879±52) μg/L比(151±35)μg/L](P＜ 0.05).术后≤3个月组并发症发生率为2.6％(1/39),明显低于术后＞3个月组的18.0％(11/61),差异有统计学意义(P＜0.05).Ⅰ组与Ⅱ组和Ⅲ组华法林用量、D-D比较差异有统计学意义[(2.56±0.21) mg比(2.94±0.57)、(3.07±0.44) mg,(793.92±42.73) μg/L比(100.96±21.56)、(61.08±20.34)μg/L](P＜ 0.05),Ⅱ组与Ⅲ组华法林用量、D-D比较差异无统计学意义(P＞0.05).三组间TpP比较差异均有统计学意义[Ⅰ、Ⅱ、Ⅲ组分别为(8.50±0.63)、(5.42±0.78)、(3.16±0.38) mg/L](P＜ 0.05).结论 结合口服华法林用量与并发症的发生情况,华法林最佳用量为(2.94±0.57)mg,INR最佳范围为1.5～ 2.5.
目的 探討瓣膜置換術後華法林的最佳安全用量.方法 選擇100例機械瓣膜置換術後患者,按不同體質量分為≤60 kg組(47例)與＞60 kg組(53例);按不同術後時間分為術後≤3箇月組(39例)及術後＞3箇月組(61例);按不同國際標準化比值(INR)分組,INR＜ 1.5為Ⅰ組(23例);INR 1.5～2.5為Ⅱ組(66例);INR＞ 2.5為Ⅲ組(11例).比較各組華法林用量,血漿血栓前蛋白(TpP)、D-二聚體(D-D)水平.結果 ≤60 kg組華法林用量為(2.90±1.11) mg,高于＞60kg組的(2.47±0.18) mg,差異有統計學意義(P＜0.05).術後≤3箇月組與術後＞3箇月組華法林用量比較差異無統計學意義(P＞0.05),兩組TpP及D-D比較差異有統計學意義[(6.32±0.01) mg/L比(4.97±0.81) mg/L、(879±52) μg/L比(151±35)μg/L](P＜ 0.05).術後≤3箇月組併髮癥髮生率為2.6％(1/39),明顯低于術後＞3箇月組的18.0％(11/61),差異有統計學意義(P＜0.05).Ⅰ組與Ⅱ組和Ⅲ組華法林用量、D-D比較差異有統計學意義[(2.56±0.21) mg比(2.94±0.57)、(3.07±0.44) mg,(793.92±42.73) μg/L比(100.96±21.56)、(61.08±20.34)μg/L](P＜ 0.05),Ⅱ組與Ⅲ組華法林用量、D-D比較差異無統計學意義(P＞0.05).三組間TpP比較差異均有統計學意義[Ⅰ、Ⅱ、Ⅲ組分彆為(8.50±0.63)、(5.42±0.78)、(3.16±0.38) mg/L](P＜ 0.05).結論 結閤口服華法林用量與併髮癥的髮生情況,華法林最佳用量為(2.94±0.57)mg,INR最佳範圍為1.5～ 2.5.
목적 탐토판막치환술후화법림적최가안전용량.방법 선택100례궤계판막치환술후환자,안불동체질량분위≤60 kg조(47례)여＞60 kg조(53례);안불동술후시간분위술후≤3개월조(39례)급술후＞3개월조(61례);안불동국제표준화비치(INR)분조,INR＜ 1.5위Ⅰ조(23례);INR 1.5～2.5위Ⅱ조(66례);INR＞ 2.5위Ⅲ조(11례).비교각조화법림용량,혈장혈전전단백(TpP)、D-이취체(D-D)수평.결과 ≤60 kg조화법림용량위(2.90±1.11) mg,고우＞60kg조적(2.47±0.18) mg,차이유통계학의의(P＜0.05).술후≤3개월조여술후＞3개월조화법림용량비교차이무통계학의의(P＞0.05),량조TpP급D-D비교차이유통계학의의[(6.32±0.01) mg/L비(4.97±0.81) mg/L、(879±52) μg/L비(151±35)μg/L](P＜ 0.05).술후≤3개월조병발증발생솔위2.6％(1/39),명현저우술후＞3개월조적18.0％(11/61),차이유통계학의의(P＜0.05).Ⅰ조여Ⅱ조화Ⅲ조화법림용량、D-D비교차이유통계학의의[(2.56±0.21) mg비(2.94±0.57)、(3.07±0.44) mg,(793.92±42.73) μg/L비(100.96±21.56)、(61.08±20.34)μg/L](P＜ 0.05),Ⅱ조여Ⅲ조화법림용량、D-D비교차이무통계학의의(P＞0.05).삼조간TpP비교차이균유통계학의의[Ⅰ、Ⅱ、Ⅲ조분별위(8.50±0.63)、(5.42±0.78)、(3.16±0.38) mg/L](P＜ 0.05).결론 결합구복화법림용량여병발증적발생정황,화법림최가용량위(2.94±0.57)mg,INR최가범위위1.5～ 2.5.
Objective To explore the best safe dose of warfarin in patients with heart valve replacement.Methods One hundred patients with heart valve replacement were selected.They were divided into ≤60 kg group(47 cases) and ＞ 60 kg group(53 cases),postoperative time ≤3 months group (39 cases) and postoperative time ＞ 3 months group(61 cases),international normalized ratio(INR) ＜ 1.5 (group Ⅰ,23 cases),INR 1.5-2.5 (group Ⅱ,66 cases),INR ＞ 2.5 (group Ⅲ,11 cases).The dose of warfarin,plasma thrombus precursor protein(TpP) and D-dimer(D-D) were compared.Results The dose of warfarin was (2.90 ± 1.11) mg in ≤ 60 kg group and (2.47 ± 0.18) mg in ＞ 60 kg group,and there was significant difference between two groups (P ＜0.05).There was no significant difference in the dose of warfarin between postoperative time ≤3 months group and postoperative time ＞ 3 months group (P＞ 0.05),but there was significant difference in TpP and D-D [(6.32 ± 0.01) mg/L vs.(4.97 ± 0.81) mg/L,(879 ± 52) μ g/L vs.(151 ± 35) μ g/L] (P ＜ 0.05).The incidence of complications was 2.6％ (1/39) in postoperative time ≤3 months group,which was lower than that in postoperative time ＞ 3 months group[18.0％(11/61)],and there was significant difference between two groups (P＜ 0.05).There was significant difference in the dose of warfarin and D-D between group Ⅰ and group Ⅱ,group Ⅲ [(2.56 ±0.21) mg vs.(2.94 ±0.57),(3.07 ±0.44) mg,(793.92 ±42.73) μg/L vs.(100.96 ± 21.56),(61.08 ± 20.34) μg/L](P＜ 0.05),but there was no significant difference between group Ⅱ and group Ⅲ (P ＞0.05).There was significant difference in TpP among three groups [(8.50 ± 0.63),(5.42 ± 0.78),(3.16 ± 0.38) mg/L in group Ⅰ,Ⅱ,Ⅲ respectively] (P ＜ 0.05).Conclusion With warfarin dose and the incidence of complications,the best dosage of wadarin is (2.94 ± 0.57) mg; the optimal range of INR is 1.5-2.5.
