心脏瓣膜置换术后华法林抗凝治疗临床分析.docVIP

心脏瓣膜置换术后华法林抗凝治疗临床分析 　　[摘要] 目的 分析心脏瓣膜置换术后应用华法林抗凝治疗的效果及并发症情况，为临床选择合适的华法林用量提供参考依据。方法 回顾性分析自2006年1月―2011年6月在该院行心脏瓣膜置换术的188例患者的临床资料，术后随访并记录患者使用华法林的用量和出现并发症的情况。结果 所有患者均成功随访，有15例出现并发症，占8.0%，其中出血10例（5.3%），栓塞5例（2.7%）；正常173例（92.0%）；出血组华法林用量、凝血酶原时间（PT）和国际标准化比值（INR）均明显大于正常组和栓塞组，差异有统计学意义（P0.05）；正常组华法林平均用量为（2.0±0.6）mg/d，PT为（18.6±2.4） s，INR为（2.1±0.5）。结论 心脏瓣膜置换术后应常规使用华法林进行抗凝治疗，将INR控制在1.8～2.5范围内可以满足抗凝要求并且明显减少并发症。 　　[关键词] 心脏瓣膜置换术；华法林；抗凝；用量 　　[中图分类号] R542.5 [文献标识码] A [文章编号] 1674-0742（2014）03（c）-0015-02 　　[Abstract] Objective To analyze the effect and complications of warfarin anticoagulant therapy after heart valve replacement so as to provide a reference for selecting appropriate warfarin dosage in clinical practice.Methods The clinical data of 188 patients with heart valve replacement admitted in our hospital from January， 2006 to June， 2011 were retrospectively analyzed. The patients were followed up postoperatively， the dosage of warfarin and postoperative complications of every patient were recorded. Results All patients were successfully followed up， and 15 cases （8.0%） developed complications， of them 10 cases （5.3%） with bleeding and 5 cases （2.7%） with embolization. 173 patients （92.0%） were normal. The warfarin dosage， prothrombin time （PT） and international normalized ratio （INR） of the hemorrhage group were significantly greater than those of the normal group and the embolism group， the differences were statistically significant （P0.05）. The average warfarin dosage of normal group was （2.0±0.6）mg/d， PT was （18.6±2.4） s and INR was （2.1±0.5）. Conclusion The warfarin should be routinely used for anticoagulation after heart valve replacement， and the INR is controlled in the range of 1.8～2.5 can meet the requirement of anticoagulant and obviously reduce the complications. 　　[Key words] Heart valve replacement； Warfarin； Anticoagulant； Dosage 　　心脏瓣膜置换术是治疗严重心脏瓣膜病尤其是风湿性心脏病的主要手术方式[1]。目前常用的人工瓣膜置换术后均需要进行常规抗凝治疗，华法林是最常用的抗凝剂。华法林的使用一直是抗凝治疗的重点，与抗凝治疗相关的各种并发症如出血、栓塞等严重影响患者的生命和生活质量[2