儿童房间隔缺损封堵术后低分子肝素抗凝疗效分析  

Low molecular weight heparin for children after transcatheter closure of atrial septal defects:efficacy and safety

作　　者：张志宏[1] 覃军[1] 黄岚[1] 李隆贵[1] 宋耀明[1] 耿召华[1] 高凌云[1] 林春梅[1] 陶春蓉[1] 

机构地区：[1]第三军医大学新桥医院心血管内科,全军心血管病研究所,重庆400037

出　　处：《第三军医大学学报》2008年第9期858-860,共3页Journal of Third Military Medical University

摘　　要：目的评价低分子肝素用于儿童房间隔缺损(atrial septal defects,ASD)封堵术后的抗凝疗效及安全性。方法48例ASD患儿分为低分子肝素组(试验组)和普通肝素组(对照组),分别在术后24h内给予皮下注射低分子肝素2次或持续静脉滴注普通肝素。检测术后24h和48h活化部分凝血活酶时间(activated partial thromboplastin time,APTT)和凝血酶原片段(prothrombin fragment1+2,F1+2)水平,并于术后第1、3个月复查经胸超声(transthoracic echocardio-graph,TTE)。结果共有43例(试验组22例,对照组21例)完成3个月随访,均无封堵器血栓形成或严重出血并发症。术前两组APTT和F1+2水平无显著性差异(P>0.05),与术前相比,术后试验组APTT无显著延长(P>0.05),对照组术后24h APTT显著延长(P<0.01),术后48h恢复术前水平(P>0.05)。术后两组F1+2水平与术前比较均显著升高(P<0.01),但两组间比较无显著性差异(P>0.05)。结论低分子肝素用于儿童ASD封堵术后安全、有效、简便,可以替代普通肝素。Objective To observe the efficacy and safety of low molecular weight heparin （LMWH） in treatment of children after transcatheter closure of atrial septal defects （ASD）. Methods Totally 48 children at age of （ 8.4±2.1 ） years and weight of （22.4±7.8 ） kg were hospitalized in our department from July 2006 to August 2007 and diagnosed as ASD with defect of 6 - 24 mm by transthoracic echocardiography （TTE）. They were randomized into 2 groups, LMWH group and common unfractionated heparin group （ heparin group）. LMWH was administered to LMWH group twice through subcutaneous injection in abdominal wall after occlusion, while unfractionated heparin was given by intervenous drop infusion for 24 h after occlusion. Activated partial thromboplastin time（AFTT） and prothrombin fragment 1 ＋ 2 （F1 ＋2） levels were determined before occlusion of ASD, at 24 h and 48 h after device implantation. TTE were performed 1,3 months after occlusion of ASD. Results TTE follow-up had been performed in 43 cases. Neither thrombus on ASD occluders nor severe hemorrhage complications was found during the follow-up period. There was no significant difference between the 2 groups in APTT and F1 ＋ 2 levels before occlusion. APTT of the heparin group was significantly prolonged at 24 h after occlusion （P 〈0.01）, but returned to normal range at 48 h （P 〉0.05）, however, such significant changes were not found in the LMWH group （P 〉0.05）. F1 ＋2 levels of the 2 groups were significantly increased after occlusion （P 〈0.01 ）, and no significant differences was seen between the 2 groups. Conclusion LMWH is a safe, effective and convenient anticoagulant in treatment of children after transcatheter closure of ASD.

关 键 词：儿童 房间隔缺损 封堵术 普通肝素 低分子肝素 

分 类 号：R619.1[医药卫生—外科学] R726.542[医药卫生—临床医学]