中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2014年
4期
43-45
,共3页
心脏瓣膜置换术%D-二聚体%抗凝治疗%栓塞%出血
心髒瓣膜置換術%D-二聚體%抗凝治療%栓塞%齣血
심장판막치환술%D-이취체%항응치료%전새%출혈
Heart valve replacement surgery%D-dimer%Anticoagulation therapy%Embolization%Bleeding
目的 探讨D-二聚体在心脏瓣膜置换术(MHVR)后不同强度抗凝治疗中的表达及意义.方法 选取85例MHVR术后出院至少2个月以上的患者,行凝血功能四项、国际标准化比值(INR)及D-二聚体检测,并根据INR水平分为三组,其中30例A组患者INR＜ 1.5,37例B组患者INR为1.5 ～2.5,18例C组患者INR ＞2.5,分别比较三组患者凝血功能四项水平及D-二聚体阳性情况.结果 A组PTR、APTT水平最低,FIB、TT水平最高,C组患者PTR、APTT水平最高,FIB、TT水平最低,B组居中,三组患者组间四项指标比较差异有统计学意义(P＜0.05).A组患者D-二聚体阳性率为30.00％,B组为8.11％,C组为5.56％,A组D-二聚体阳性率明显高于其他两组(P＜0.05).A组2例(6.66％)发生血栓,1例(3.33％)出血;B组1例(2.7％)发生出血;C组1例(5.56％)发生下肢栓塞,2例(11.11％)发生出血,三组患者并发症发生率比较差异无统计学意义(P＞0.05).结论 D-二聚体在MHVR抗凝状态检查中占有很重要的地位,其血浆水平对血栓发生具有重要的预测价值,尤其对于低强度抗凝治疗者,对于D-二聚体水平升高而患者无明显临床症状者也需注意监测,以防止血栓的发生.
目的 探討D-二聚體在心髒瓣膜置換術(MHVR)後不同彊度抗凝治療中的錶達及意義.方法 選取85例MHVR術後齣院至少2箇月以上的患者,行凝血功能四項、國際標準化比值(INR)及D-二聚體檢測,併根據INR水平分為三組,其中30例A組患者INR＜ 1.5,37例B組患者INR為1.5 ～2.5,18例C組患者INR ＞2.5,分彆比較三組患者凝血功能四項水平及D-二聚體暘性情況.結果 A組PTR、APTT水平最低,FIB、TT水平最高,C組患者PTR、APTT水平最高,FIB、TT水平最低,B組居中,三組患者組間四項指標比較差異有統計學意義(P＜0.05).A組患者D-二聚體暘性率為30.00％,B組為8.11％,C組為5.56％,A組D-二聚體暘性率明顯高于其他兩組(P＜0.05).A組2例(6.66％)髮生血栓,1例(3.33％)齣血;B組1例(2.7％)髮生齣血;C組1例(5.56％)髮生下肢栓塞,2例(11.11％)髮生齣血,三組患者併髮癥髮生率比較差異無統計學意義(P＞0.05).結論 D-二聚體在MHVR抗凝狀態檢查中佔有很重要的地位,其血漿水平對血栓髮生具有重要的預測價值,尤其對于低彊度抗凝治療者,對于D-二聚體水平升高而患者無明顯臨床癥狀者也需註意鑑測,以防止血栓的髮生.
목적 탐토D-이취체재심장판막치환술(MHVR)후불동강도항응치료중적표체급의의.방법 선취85례MHVR술후출원지소2개월이상적환자,행응혈공능사항、국제표준화비치(INR)급D-이취체검측,병근거INR수평분위삼조,기중30례A조환자INR＜ 1.5,37례B조환자INR위1.5 ～2.5,18례C조환자INR ＞2.5,분별비교삼조환자응혈공능사항수평급D-이취체양성정황.결과 A조PTR、APTT수평최저,FIB、TT수평최고,C조환자PTR、APTT수평최고,FIB、TT수평최저,B조거중,삼조환자조간사항지표비교차이유통계학의의(P＜0.05).A조환자D-이취체양성솔위30.00％,B조위8.11％,C조위5.56％,A조D-이취체양성솔명현고우기타량조(P＜0.05).A조2례(6.66％)발생혈전,1례(3.33％)출혈;B조1례(2.7％)발생출혈;C조1례(5.56％)발생하지전새,2례(11.11％)발생출혈,삼조환자병발증발생솔비교차이무통계학의의(P＞0.05).결론 D-이취체재MHVR항응상태검사중점유흔중요적지위,기혈장수평대혈전발생구유중요적예측개치,우기대우저강도항응치료자,대우D-이취체수평승고이환자무명현림상증상자야수주의감측,이방지혈전적발생.
Objective To investigate the expression of D-dimer in different anticoagulation intensity of mechanical heart valve replacement (MHVR) surgery and its clinical significance.Methods Eighty-five cases of MHVR,discharged from hospital for at least 2 months were selected,coagulation function four,INR and D-dimer testing were detected,and the patients were divided into three groups according to INR levels,and 30 patients with INR ＜ 1.5 in group A,37 patients with INR at 1.5-2.5 in group B,18 patients with INR ＞ 2.5 in group C.The coagulation function and D-dimer of the three groups were compared.Results In group A,the levels of PTR,APTT were the lowest,the levels of FIB,TT were the highest; In group C,the levels of PTR,APTT were the highest,the levels of FIB,TT were the lowest ; the levels of PTR,APTT,FIB,TT in group B were the moderate,there were significant differences among the three groups (P＜0.05).The positive D-dimer rate was 30.00％ in group A,and 8.11％ in group B,5.56％ in group C,the level of D-dimer was significantly higher in group A than that in the other two groups (P ＜ 0.05).There were 2 cases (6.66％) of thrombosis in group A,1 case of bleeding in group A,1 case (2.7％) of bleeding in group B,1 case (5.56％) of lower extremity thrombosis in group C,2 cases (11.11％) of bleeding in group C,the incidences of complications had no significant difference among the three groups (P ＞ 0.05).Conclusions D-dimer plays a very important role in MHVR anticoagulation status check,and its plasma levels has important predictive value on thrombosis,especially for lowintensity anticoagulation therapy.For elevated levels of D-dimer,while patients have no obvious clinical symptoms,also need to be monitored,in order to prevent the occurrence of thrombosis.
