心脏瓣膜置换并射频消融术后华法林抗凝治疗的方法探讨  

Investigation of reasonable warfarin anticoagulation therapy in open heart valve replacement with radiofrequency ablation

作　　者：刘寅强[1] 陶杰[1] 蔡冰[1] 杨百晖[1] 夏建民[1] 张学玉[1] 张桂敏[1] 

机构地区：[1]昆明医学院第一附属医院,昆明650032

出　　处：《山东医药》2012年第18期10-12,共3页Shandong Medical Journal

基　　金：云南省科技厅创新团队基金资助项目(2011CI137)

摘　　要：目的探讨心脏瓣膜置换并直视射频消融术后华法林的抗凝治疗方法。方法将130例心脏瓣膜病合并房颤患者分为2组,A组(60例)行瓣膜置换并射频消融术治疗,术后服用胺碘酮治疗6个月,同时服用华法林抗凝治疗;B组(70例)单纯行瓣膜置换术治疗,术后仅服用华法林抗凝治疗。结果术后随访3～16个月,A、B组死亡各1例,均为非抗凝相关死亡。A组出现抗凝所致轻度出血5例、血栓栓塞0例,INR异常升高4例;B组分别为3、3、1例。两组比较,P均>0.05。达抗凝稳态时,两组不同术式患者华法林剂量比较,P均>0.05。达到抗凝稳态时,A组华法林剂量为(2.43±0.58)mg/d,INR为1.83±0.55。结论瓣膜置换同期直视射频消融术后患者应加强抗凝监测,根据INR适度减少华法林用量,避免发生出血。Objective To investigate the therapy of reasonable warfarin anticoagnlation in heart valve replacement with radiofrequency ablation. Methods 130 cases of valvular heart disease with atrial fibrillation in patients were divided into 2 groups according to treatment. The general information of two groups was no significant difference. Pateints in group A （n =60） were given heart valve replacement with radiofrequency ablation, took amiodarone 6 month and warfarin antieoagnlant therapy together after operation; Patients in group B （ n -- 70） were given the only separate valve replacement surgery, took only warfarin anticoagulant therapy. Two groups were used low-intensity anticoagulation standard in INR values 1.5 -2.5 and observed between the anticoagulant effect and warfarin anticoagulant dose. Results Patients were followed up for 3 to 16 months,and 1 died, 1 lost in group A; 1 died in group B. There were not anticoagulant-related deaths. Group A caused mild bleeding 5 cases, severe bleeding 0 cases, thromboembolism 0 cases, abnormal elevation of the INR value （INR 〉4） 4 cases. Group B caused cases of 3,0,3,1. To compare these values in the two groups, P〉0.05. When anticoagulant steady state was reached in the group A, the warfarin dose of mitral valve replacement was （2.31 ± 0.87） mg/d, aortic valve replacement was 3. 125 rag/d, the double valve replacement was （2.74 ± 0.44） mg/d. The warfarin dose in group B were（2.59 ±0.75） ,（3.47 ±0.44） ,（2.78 ±0.90） mg/d. To compare these values in the two groups, P 〉 0.05. When anticoagulant steady state was reached in the group A, the comparison histogram between dose of warfarin and the number of patients showed that dose of warfarin was （2.43 ± 0.58 ） mg/d, the comparison histogram between the ratio INR and the number of patients showed INR was 1.83 ± 0.55. Conclusion The low-intensity anticoagulation standard of INR values 1.5 - 2.5 and got satisfied anticoagulant effect for the patients who finished the operation of valve

关 键 词：华法林 抗凝疗法 国际标准化比值 瓣膜置换术 射频消融术 心房纤颤 心脏瓣膜病 

分 类 号：R654.2[医药卫生—外科学]