中国医药
中國醫藥
중국의약
CHINA MEDICINE
2015年
1期
103-105
,共3页
王永伟%刘朋%牛连生%胡三保
王永偉%劉朋%牛連生%鬍三保
왕영위%류붕%우련생%호삼보
心脏瓣膜,人工%围术期%低分子肝素%华法林
心髒瓣膜,人工%圍術期%低分子肝素%華法林
심장판막,인공%위술기%저분자간소%화법림
Heart valve prosthesis%Peri-operative%Low molecular weight heparin%Warfarin
目的 探讨心脏机械瓣膜置换术后行骨科手术患者围术期抗凝治疗的方法.方法 回顾性分析1998年10月至2014年10月首都医科大学附属北京安贞医院人工心脏机械瓣膜置换术后行骨科手术的50例患者临床资料.患者术前3d开始停用华法林,采用1 mg/kg低分子肝素替代治疗,皮下注射,1次/12 h,术前12h停用,术后24h开始恢复使用低分子肝素,术后48 h开始口服华法林,凝血酶原时间国际标准化比值大于1.5时停用低分子肝素,逐渐调整华法林至合适用量.记录患者围术期出血量、卡瓣率(超声心动复查是否有瓣膜血栓形成,瓣膜功能是否正常)和深静脉血栓发生率,比较患者手术前后血红蛋白水平.结果 50例患者术中出血量为200 ～ 550 ml,平均(320±75) ml;术后引流量为380～ 750 ml,平均(580±85)ml.术后5例患者出现出血,给予相应治疗后好转.所有患者未发现瓣膜血栓形成和下肢深静脉血栓.术前与术后第4、10天的血红蛋白比较,差异无统计学意义[(120±9)g/L比(117±11)、(118±12)g/L,均P＞0.05].结论 心脏瓣膜置换术后行骨科手术患者围术期应用低分子肝素替代华法林抗凝治疗可有效防止大量失血、卡瓣、深静脉血栓形成等严重并发症.
目的 探討心髒機械瓣膜置換術後行骨科手術患者圍術期抗凝治療的方法.方法 迴顧性分析1998年10月至2014年10月首都醫科大學附屬北京安貞醫院人工心髒機械瓣膜置換術後行骨科手術的50例患者臨床資料.患者術前3d開始停用華法林,採用1 mg/kg低分子肝素替代治療,皮下註射,1次/12 h,術前12h停用,術後24h開始恢複使用低分子肝素,術後48 h開始口服華法林,凝血酶原時間國際標準化比值大于1.5時停用低分子肝素,逐漸調整華法林至閤適用量.記錄患者圍術期齣血量、卡瓣率(超聲心動複查是否有瓣膜血栓形成,瓣膜功能是否正常)和深靜脈血栓髮生率,比較患者手術前後血紅蛋白水平.結果 50例患者術中齣血量為200 ～ 550 ml,平均(320±75) ml;術後引流量為380～ 750 ml,平均(580±85)ml.術後5例患者齣現齣血,給予相應治療後好轉.所有患者未髮現瓣膜血栓形成和下肢深靜脈血栓.術前與術後第4、10天的血紅蛋白比較,差異無統計學意義[(120±9)g/L比(117±11)、(118±12)g/L,均P＞0.05].結論 心髒瓣膜置換術後行骨科手術患者圍術期應用低分子肝素替代華法林抗凝治療可有效防止大量失血、卡瓣、深靜脈血栓形成等嚴重併髮癥.
목적 탐토심장궤계판막치환술후행골과수술환자위술기항응치료적방법.방법 회고성분석1998년10월지2014년10월수도의과대학부속북경안정의원인공심장궤계판막치환술후행골과수술적50례환자림상자료.환자술전3d개시정용화법림,채용1 mg/kg저분자간소체대치료,피하주사,1차/12 h,술전12h정용,술후24h개시회복사용저분자간소,술후48 h개시구복화법림,응혈매원시간국제표준화비치대우1.5시정용저분자간소,축점조정화법림지합괄용량.기록환자위술기출혈량、잡판솔(초성심동복사시부유판막혈전형성,판막공능시부정상)화심정맥혈전발생솔,비교환자수술전후혈홍단백수평.결과 50례환자술중출혈량위200 ～ 550 ml,평균(320±75) ml;술후인류량위380～ 750 ml,평균(580±85)ml.술후5례환자출현출혈,급여상응치료후호전.소유환자미발현판막혈전형성화하지심정맥혈전.술전여술후제4、10천적혈홍단백비교,차이무통계학의의[(120±9)g/L비(117±11)、(118±12)g/L,균P＞0.05].결론 심장판막치환술후행골과수술환자위술기응용저분자간소체대화법림항응치료가유효방지대량실혈、잡판、심정맥혈전형성등엄중병발증.
Objective To explore the effect of peri-operative anticoagulation of orthopaedic surgery among patients who had a previous cardiac mechanical valvereplacement.Methods Fifty patients with artificial cardiac valve who underwent orthopaedic surgery were retrospectively studied.Warfarin was replaced by continuous low molecularweight heparin(LMWH) 3 days before operation.LMWH was started 24 hours after operation.Warfarin was taken 48 hours after operation.LMWH was stopped when International Normalized Ratio exceeded 1.5.Warfarin should be regulated to reasonable dosage.The peri-operative bleeding,whether the valve had thrombosis,whether the normal valve function was good and the incidence of deep venous thrombosis were recorded.Results In 50 patients,the peri-operative bleeding was 200-550 ml,the average was (320 ± 75)ml.There was no serious postoperative bleeding and five cases had hyporrhea.No embolism was found in the valve and deep veins of lower limb.Compared with preoperative data,the hemoglobin at 4,10 days after the operation was not significantly changed[(117 ±11),(118±12)g/L vs (120±9)g/L,P＞0.05].Conclusion LMWH can be used for perioperative anticoagulation in patients with a history of cardiac valve replacement before orthopaedic surgery.
