CAJ | 학술논문

目的：探讨活化凝血时间（ACT）监测对心脏瓣膜置换术患者低分子肝素剂量及伤口引流量的影响。方法将医院心血管外科体外循环下行心脏瓣膜置换术的100例患者随机分为对照组和观察组，各50例。两组患者均给予低分子肝素抗凝，对照组未行ACT监测，观察组行ACT监测。结果术后10 h，观察组引流量和悬浮红细胞输入量均明显低于对照组（ P﹤0.05）；两组患者凝血酶原时间（PT）较术前均明显延长，组间比较，差异无统计学意义（ P﹥0.05）；对照组患者部分活化凝血酶原时间（APTT）较术前明显延长（ P﹤0.05），观察组无显著变化（ P﹥0.05），对照组较观察组明显延长（ P﹤0.05）；术后24 h，两组患者PT较术前无明显差异，但对照组APTT仍较术前明显延长（ P﹤0.05），且显著长于观察组（ P﹤0.05）；观察组不良反应发生率显著低于对照组（ P﹤0.05）。结论体外循环下心脏瓣膜置换术后行ACT监测，能适时调整低分子肝素使用剂量，有助于减少伤口平均引流量和悬浮红细胞输入量，同时也减少APTT等指标波动和出血等不良反应的发生，值得临床推广。
목적：탐토활화응혈시간（ACT）감측대심장판막치환술환자저분자간소제량급상구인류량적영향。방법장의원심혈관외과체외순배하행심장판막치환술적100례환자수궤분위대조조화관찰조，각50례。량조환자균급여저분자간소항응，대조조미행ACT감측，관찰조행ACT감측。결과술후10 h，관찰조인류량화현부홍세포수입량균명현저우대조조（ P﹤0.05）；량조환자응혈매원시간（PT）교술전균명현연장，조간비교，차이무통계학의의（ P﹥0.05）；대조조환자부분활화응혈매원시간（APTT）교술전명현연장（ P﹤0.05），관찰조무현저변화（ P﹥0.05），대조조교관찰조명현연장（ P﹤0.05）；술후24 h，량조환자PT교술전무명현차이，단대조조APTT잉교술전명현연장（ P﹤0.05），차현저장우관찰조（ P﹤0.05）；관찰조불량반응발생솔현저저우대조조（ P﹤0.05）。결론체외순배하심장판막치환술후행ACT감측，능괄시조정저분자간소사용제량，유조우감소상구평균인류량화현부홍세포수입량，동시야감소APTT등지표파동화출혈등불량반응적발생，치득림상추엄。
Objective To investigate the influence of activated coagulation time (ACT) monitoring on the low molecular weight heparin dosage and wound drainage after cardiac valve replacement. Methods 100 cases of patients with cardiac valve replacement surgery un-der extracorporeal circulation in the hospital were randomly divided into the control group and the observation group,50 cases in each group. The two groups were given low molecular weight heparin;the observation group performed ACT,and the control group did not perform ACT. Results 10 h after operation,the amount of suspended red blood cells in the observation group were significantly lower than those in the control group( P ﹤ 0. 05). PT was significantly longer in the two groups than before operation,but with no statistical difference between the two groups( P ﹥ 0. 05);APTT was significantly longer in the control group( P ﹤ 0. 05),and had no obvious change in the observation group( P ﹥ 0. 05),the control group was obviously longer than the observation group( P ﹤ 0. 05). 24 h after operation,the PT in the two groups had no obvious difference compared with before,but APTT in the control group was still longer than before( P ﹤ 0. 05),and significantly longer than the observation group( P ﹤ 0. 05);the incidence rate of adverse reactions in the control group was significantly higher than that in the observation group( P ﹤ 0. 05). Conclusion ACT monitoring after cardiac valve replacement under extracorporeal circulation can adjust the dosage of low molecular weight heparin,is conducive to reducing the average wound drainage and suspended red blood cell input,while also reducing the occurrence of fluctuations in indicators such as APTT and adverse reactions such as bleeding,and is worth of clinical promotion.