二尖瓣位机械瓣膜置入术后早期低分子肝素抗凝疗效的初步观察  

Low-molecular-weight heparin as an bridging anticoagulant early after mechanical mitral valve replacement in swine

作　　者：李德闽[1] 申翼[1] 王常田[1] 任斌辉[1] 牛冬梅[1] 景华[1] 黄楠[2] 

机构地区：[1]南京军区南京总医院心胸外科,江苏南京210002 [2]西南交通大学材料学院,四川成都610031

出　　处：《医学研究生学报》2007年第8期802-805,共4页Journal of Medical Postgraduates

基　　金：973国家重点基础研究规划项目基金资助(批准号:G1999064705)

摘　　要：目的：观察二尖瓣位机械瓣膜置换术后早期低分子肝素（LMWH）和普通肝素（UFH）桥接抗凝的效果.方法：16只小型猪心肺转流术下行二尖瓣位机械瓣膜置换术,术后按桥接抗凝方法的不同随机分为LMWH组和UFH组,每组8只.结果：两组小型猪无手术死亡,UFH组和LMWH组的桥接抗凝时间分别为（9.75±2.19）d和（8.88±1.96）d,P=0.414.桥接抗凝第2d时,UFH组仅1只小型猪的活化部分凝血活酶时间（APTT）达到有效抗凝水平（对照值的1.5～2.5倍）,而LMWH组7只小型猪抗Xα因子达到有效抗凝水平（0.5～1.0u/ml）.终止桥接抗凝前,UFH组2只小型猪APTT保持在有效抗凝水平,LMWH组7只抗Χa因子保持有效抗凝水平.UFH组和LMWH组平均生存时间分别为（73.0±52.0）d 和（102.5±38.1）d,P=0.217.UFH组2只小型猪分别于术后9d和18d死于心包填塞及瓣周血栓致瓣膜失功;另有3只分别因脑肾梗死、败血症和肺部感染于术后31、56和84d死亡,其余3只存活时间超过90d.LMWH组3只小型猪分别于术后54、82和85d因肺部感染和心力衰竭死亡,其余5只存活时间超过90d.结论：LMWH用于机械瓣膜置换术后早期桥接抗凝治疗,具有安全及使用方便的优点.Objective ：To observe the feasibility of low-molecular-weight heparin （LMWH） therapy as a bridge early after mechanical mitral valve replacement in swine. Methods：Sixteen male Bama Miniature cutaneous LMWH and warfarin, in which 8 animals was included in each group）. Results：The meanduration of bridging was （9.75 ± 2.19） days for UFH and （8.88 ± 1.96 ） days for LMWH （P = 0. 414 ）. On the second day of bridging therapy, only one animal with UFH had an APTT value within 1.5 to 2.5 times of control , but 7 animals with LMWH had an anti-Xa activity within 0.5 to 1.0 u/ml. On the last day of prescription, 7 LMWH-treated animals had anti-Xa activity within the therapeutic range, but 2 animals had an APTT within the therapeutic range. The mean survival time was （73.0 ±52.0） days and （102.5 ±38.1 ） days in the UFH and LMWH groups respectively（P =0.217）. In UFH group , one animals died from hemopericardium on the 9th postoperative day and another died from valve thrombosis on the 18th postoperative day. Three animals died from multiple infarction, pyosepticemia and pulmonary infection on the postoperative day of 31, 56 and 84 respectively. The rest of 3 animals survived over 3 months. In LMWH group, 2 animals died on postoperative day of 54 and 82 due to pulmonary complica tion and another one died from chronic heart failure on 85th day postoperatively. The remaining animals survived over 3 months. Conclusion ： Bridging therapy with LMWH appears to be safe and feasible early after mechanical heart valve replacement.

关 键 词：小型猪 人造心脏瓣膜 抗凝 肝素 

分 类 号：R542.51[医药卫生—心血管疾病]