房间隔缺损封堵术后不同抗凝方案安全性及疗效分析  

Safety and Efficacy of Different Anticoagulant Protocols after Transcatheter Closure of Atrial Septal Defect

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全军心血管病研究所,重庆400037

出　　处：《中国介入心脏病学杂志》2010年第5期247-251,共5页Chinese Journal of Interventional Cardiology

基　　金：重庆市重点攻关课题(cstc;2009AB5033)

摘　　要：目的评价房间隔缺损封堵术后不同抗凝方案的安全性及疗效。方法 56例房间隔缺损患者分入三组并于封堵术后给予不同抗凝方案:即肝素组(16例)持续静滴肝素钠10U.kg-1.h-1、共24h;低分子肝素组(20例)腹壁皮下注射依诺肝素1mg/kg、每12h1次,共2次和延长低分子肝素组(20例)依诺肝素用法用量同低分子肝素组、但术后连续使用3天,共6次。三组均于封堵术前2天起口服阿司匹林3mg·kg-1.d-1,至术后6个月。封堵术后三组均临床随访3个月,并于术后第30、90天复查经胸心脏超声;术后第4天测定活化部分凝血活酶时间(APTT);术后第4、7、30和90天测定血浆β-血小板球蛋白(β-TG)、血小板第4因子(PF4)和凝血酶原片段1+2(F1+2)浓度。结果 (1)封堵术后三组均无封堵器血栓形成和严重出血并发症,术后第4天三组APTT均在正常参考值范围内;(2)术前三组间β-TG、PF4和F1+2浓度差异均无统计学意义(P>0.05)。术后第4天,低分子肝素组β-TG、PF4和F1+2浓度与肝素组相比差异均无统计学意义(P>0.05),延长低分子肝素组β-TG浓度较肝素组低16%(P<0.05)、与低分子肝素组相比差异无统计学意义(P>0.05),PF4浓度较肝素组和低分子肝素组差异均无统计学意义(P>0.05),F1+2浓度较肝素组低8%(P=0.018)、较低分子肝素组低11%(P=0.035);(3)术后第7、30和90天,三组间β-TG、PF4和F1+2浓度差异均无统计学意义(P>0.05)。结论与肝素相比,低分子肝素用于房间隔缺损封堵术后抗凝两者安全性及疗效相当,延长低分子肝素疗程至术后第3天有利于降低房间隔缺损封堵术后血栓形成风险,且不增加出血风险。Objective To evaluate the safety and efficacy of different anticoagulant protocols after transcatheter closure of Atrial septal defect（ASD）.Methods Fifty six patients who had underwent successful transcatheter closure of ASD were included in this study.All the patients were randomized into 3 groups：the UFH group（n=16）,who received intravenous Unfractionated heparin（UFH,10 IU·kg-1·h-1）for 24 hours after occlusion of ASD;the LMWH group infusion（n=20）,who was administered with low molecular weight heparin（LMWH：Enoxaparin 1 mg/kg,every 12 hours）by subcutaneous injection in the abdominal wall within 24 hours after occlusion of ASD,the prolonged LMWH group（n=20）,who was given LMWH for up to 3 days after occlusion of ASD（usage and dose as the LMWH group）.All the patients were instructed to take aspirin 3 mg/kg daily 2 days before occlusion of ASD and mainteined for 6 months after occlusion.Activated partial thromboplastin time（APTT）was determined before occlusion of ASD and at the 4th day after occlusion.Fasting blood samples were obtained before occlusion and at 4,7,30,90 days after device implantation.Enzyme-linked immunosorbent assay（ELISA）was used to measure the levels of Beta-thromboglobulin（β-TG）,Platelet factor 4（PF4）and Prothrombin fragment 1＋2（F1＋2）in the plasma.All the patients were followup clinically for 3 months and were evaluated by Tranthoracic echocardiography at 30 and 90 days after occlusion.Results（1）There were no thromboembolic events and serious hemorrhage complications in all groups.Levels of APTT among the three groups kept within normal range.（2）Baseline characteristics were similar across the three groups before occlusion.Levels of β-TG,PF4 and F1＋2 between the UFH group and the LMWH group were similar at the 4th day after device implanted（P0.05）.Levels of F1＋2 were lower in the prolonged LMWH group than the UFH group and the LMWH group at the 4th day after occlusion of ASD（P=0.018 and 0.035 respectively）.（3）Ther

关 键 词：房间隔缺损 封堵 抗凝 肝素 肝素 低分子量 

分 类 号：R654.2[医药卫生—外科学]