机械瓣置换术后早期患者华法林稳定剂量的影响因素分析  

Influence factors of the stable warfarin dose in the early period after mechanical prosthetic valve replacement

作　　者：何帆[1,2] 任荣[1] 刘关键[3] 邓云丹[1] 林富顺 肖锡俊[1] 

机构地区：[1]四川大学华西医院心脏血管外科,成都610041 [2]浙江大学医学院附属邵逸夫医院心脏中心,杭州310020 [3]四川大学华西医院中国循证医学中心,成都610041

出　　处：《中国胸心血管外科临床杂志》2017年第5期363-368,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的对影响心脏机械瓣置换术后早期患者华法林稳定剂量的相关因素进行分析,以期指导患者术后早期的抗凝治疗。方法 2012年7月至2014年4月门诊随访时登记在四川大学华西医院行机械瓣置换术后早期(≤6个月)288例患者的基本信息(姓名、性别、年龄、身高、体质量等)、一般临床资料(心功能、心律、手术方式等)及门诊复查时的抗凝治疗相关数据,其中男93例、女195例,年龄21~68(47.30±9.31)岁。本研究所采用的目标国际标准化比值(INR)范围为1.60~2.20,可接受的INR范围为1.50~2.30。以周为单位进行华法林剂量的调整,当INR超出可接受的范围时进行相应的华法林剂量调整。以纳入患者的性别、年龄、身高、体质量、体质量指数、体表面积及相关临床因素为观察指标,分析这些指标与术后早期患者华法林稳定剂量的相关性。结果性别是影响机械瓣置换术后早期患者华法林稳定剂量的因素之一(P<0.05),女性患者术后早期抗凝治疗所需的华法林稳定剂量低于男性患者。而在不同年龄、心律、心功能、手术方式的患者之间华法林稳定剂量的差异并无统计学意义(P>0.05)。术前合并的疾病对患者早期华法林稳定剂量无显著影响(P>0.05);同期行射频消融术的心房颤动患者则其术后所需的华法林稳定剂量显著低于那些未同期行射频消融术的心房颤动患者(P<0.05)。年龄、身高、体质量、体质量指数、体表面积与华法林稳定剂量之间有相关性,其影响程度(R2)分别为1.2%,3.2%,3.5%,1.1%,4.2%;以华法林稳定剂量为因变量,以年龄、身高、体质量、体质量指数、体表面积为自变量的多元回归分析方程可解释6.1%的华法林稳定剂量。结论在机械瓣置换术后早期给予患者抗凝治疗时应考虑不同的术前因素、药物因素及人口学因素对患者华法林稳定剂量的影响;华法林稳定剂量与年龄、身高、体质Objective Influence factors of the stable warfarin dose in the early period after mechanical prosthetic valve replacement were analyzed to guide the anticoagulation therapy for these patients. Methods A total of 288 patients within 6 months after mechanical prosthetic valve replacement in West China Hospital were followed up and registered at outpatient department from July 2012 to April 2014, including basic information （name, sex, age, height, weight, etc.）, general clinical data （cardiac function, heart rate, surgery pattern, etc.） and related data about anticoagulation therapy. The target international standardized ratio （INR） range was 1.60 to 2.20 and the acceptable INR was 1.50 to 2.30. The sex, age, height, body weight, body mass index （BMI）, body surface area （BSA） and related clinical factors were analyzed to find the relationship with the dose of warfarin. Results Sex was found to have a significant effect on the stable warfarin dose （P〈0.05）. Women needed a lower stable warfarin dose than men during the early anticoagulation therapy. There was no significant difference in the stable warfarin dose of patients with different ages, rhythms, NYHA classification, surgery pattern and diseases before operation; but the stable warfarin dose was lower in the patients with radiofrequency ablation during valve replacement procedures than the patients with single valve replacement （P〈0.05）. There was an association between age, height, weight, BMI, BSA and the stable warfarin dose withR^2 of 1.2%, 3.2%, 3.5%, 1.1%, 4.2%, respectively and they could explain 6.1% of variability in warfarin dose. Conclusion During early anticoagulation therapy in patients with mechanical prosthetic valve replacement, it is necessary to consider the effects of various preoperative factors, drug factors and demographic factors on warfarin dose. Even though there is an association between age, height, weight, BMI, BSA and the stable warfarin dose, which can only explain 6.1% of variability in warfarin do

关 键 词：机械瓣置换 早期抗凝 华法林剂量 影响因素 

分 类 号：R654.2[医药卫生—外科学]