腹股沟疝合并心房颤动患者的围手术期抗凝治疗  

Perioperative Anticoagulation in Patients with Inguinal Hernia and Atrial Fibrillation

作　　者：张明[1] 朱信强[1] 丁闯[1] 孔令永[1] 陈焰[1] 

机构地区：[1]南京鼓楼医院集团宿迁市人民医院普外科胃肠中心,江苏省宿迁市223800

出　　处：《医学理论与实践》2016年第23期3181-3183,共3页The Journal of Medical Theory and Practice

摘　　要：目的:探讨腹股沟疝合并心房颤动长期口服抗凝药物患者术前是否需要肝素桥接抗凝治疗。方法:对我院2013年1月-2015年10月接受腹股沟疝无张力修补术的房颤患者共76例进行分析。将患者随机分为两组:接受桥接抗凝治疗组(实验组)36例,安慰剂组40例(给以相同剂量的生理盐水注射)。患者在术前停用华法林5d,皮下注射生理盐水或低分子肝素的桥接治疗直至术前24h。对两组患者术后抗凝相关并发症进行比较。结果:安慰剂组与实验组患者手术前后PLT、纤维蛋白原(FIB)及D-二聚体变化无明显差异(P>0.05),实验组患者皮下血肿及切口渗血发生率略大于安慰剂组,但差异无统计学意义(P>0.05),两组患者术后动静脉血栓的发生率及心肌梗死的发生率无明显差异(P>0.05)。结论:腹股沟疝合并心房颤动患者桥接抗凝治疗与安慰剂组相比,血栓栓塞并发症的风险无统计学差异,但略增加出血风险。Objective：To investigate the need of heparin bridging anticoagulation therapy for patients with chronic inguinal hernia complicated with atrial fibrillation before operation.Methods：A total of 76 patients with atrial fibrillation undergoing inguinal hernia repair in our hospital from January 2013 to October 2015 were analyzed in cases.Patients were randomly divided into two groups,36 patients were treated with bridging anticoagulant therapy group（experimental group）and 40 patients in the placebo group（Give the same measure of physiological saline injection）.Patients in the preoperative warfarin was stopped for 5days,24 hours before subcutaneous injection of saline or low molecular weight heparin bridging therapy until surgery.The postoperative anticoagulation related complications were compared between the two groups.Results：In the placebo group and the experimental group,there was no significant difference in the PLT,fibrinogen and D-two polymer before and after surgery.In the experimental group,the incidence of subcutaneous hematoma and incision infiltration was slightly greater than that of the placebo group,but there was no statistically significant difference.There was no significant difference in the incidence of postoperative arterial and venous thrombosis and myocardial infarction in the two groups.Conclusion：There was no significant difference in the risk of thromboembolism complications between patients with inguinal hernia and patients with atrial fibrillation,but slightly increased risk of bleeding.

关 键 词：心房颤动 腹股沟疝 抗凝治疗 桥接抗凝 

分 类 号：R656.21[医药卫生—外科学] R541.75[医药卫生—临床医学]