心脏机械瓣膜置换术后抗凝监测的方法学研究及临床意义  

Methodologic study and clinical significance of anticoagulation monitoring following mechanical heart valve replacement

作　　者：董力[1] 石应康[1] 刘小菁[2] 黄英[3] 粟军[4] 梁茂植[3] 

机构地区：[1]华西医科大学附属第一医院胸心外科,成都610041 [2]华西医科大学附属第一医院内科实验室,成都610041 [3]华西医科大学附属第一医院临床药理研究所,成都610041 [4]华西医科大学附属第一医院检验科,成都610041

出　　处：《中华胸心血管外科杂志》2001年第5期260-262,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家教委高等学校博士点基金资助(编号9504128)

摘　　要：目的　探讨定量检测血浆中凝血酶原及华法林浓度等指标 ,在心脏机械瓣膜置换术后抗凝监测中的意义。方法　动态监测 6 5例心脏机械瓣膜置换术后抗凝病人血浆凝血酶原、华法林血药浓度、凝血因子VII活性、国际标准比值 (INR)、口服华法林剂量及临床并发症情况。比较出血组与对照组间各种抗凝监测指标的差异。结果　 (1)出血组血浆凝血酶原浓度 (81 45± 41 2 7)mg/L明显低于对照组(12 8 5 5± 31 5 8)mg/L(P <0 0 1) ,华法林血药浓度 (5 46 93± 148 18)ng/ml则明显高于对照组(399 47± 10 7 2 8)ng/ml(P <0 0 5 ) ;两组间INR值、VII因子活性及口服华法林剂量差异均不明显 (P >0 0 5 ) ;(2 )动态观察华法林血药浓度及血浆凝血酶原值稳定性较INR值好 ;(3)血浆凝血酶原浓度与华法林血药浓度 (r=- 0 849;P <0 0 1)以及INR值与VII因子活性 (r =- 0 781;P <0 0 1)明显相关。Objective: To investigate the possibility of quantitative test of plasma prothrombin and warfarin in anticoagulation monitoring following mechanical heart valve replacement. Methods: Plasma concentrations of prothrombin and warfarin, activity of coagulation factor VII (F VII), international normalized ratio(INR), oral dosage of warfarin and anticoagulation complications were measured and analyzed in 65 anticoagulation patients following mechanical heart valve replacement. Results: Plasma concentration of prothrombin in bleeding group [(81 45±41 27)mg/L] was significanlty lower than that in control group [(128 55±31 58)mg/L] (P<0 01) . The warfarin concentration in bleeding group [(546 93±148 18)ng/ml] was significanlty higher than in control group [(339 47±107 28)ng/ml](P<0 05). There was no difference in INR, F VII activity and dosage of oral warfarin between these two groups(P>0 05). The plasma concentrations of prothrombin and warfarin were more stable than INR valve. There were close correlation between plasma prothrombin and warfarin (r=0 849,P<0 01), INR and F VII(r=-0 781,P<0 01). Conclusion: The quantitative measurement of plasma concentrations of prothrombin and warfarin will be helpful in monitoring anticoagulation therapy following mechanical heart valve replacement.

关 键 词：心脏瓣膜 人工 手术后并发症 抗凝药 国际标准比值 

分 类 号：R654.2[医药卫生—外科学]