主动脉瓣机械瓣置换术后患者妊娠期抗凝治疗的前瞻性研究  

Prospective study for anticoagulant therapy throughout pregnancy in patients after mechanical aortic valve replacement

作　　者：薛清[1] 李宁[1] 褚恒[1] 韩林[1] 徐志云[1] 

机构地区：[1]第二军医大学附属长海医院心血管外科,上海200433

出　　处：《国际心血管病杂志》2018年第1期54-57,共4页International Journal of Cardiovascular Disease

基　　金：国家科技部重点研发计划(2016YFC1100900);国家自然科学基金(81770383)

摘　　要：目的:研究主动脉瓣机械瓣置换术后患者妊娠期的抗凝方案。方法:将2013年1月至2017年1月在长海医院进行产检的主动脉瓣机械瓣置换术后妊娠患者120例随机分为4组,分别选用不同的抗凝方案:A组全孕期口服国产华法林;B组孕12周前皮下注射低分子肝素钙,孕12周后口服国产华法林;C组全孕期口服进口华法林;D组孕12周前皮下注射低分子肝素钙,孕12周后口服进口华法林。各组患者国际标准化比值均控制在1.5~2.0。结果:(1)C组和D组服用华法林的剂量明显低于A组和B组。(2)4组产妇流产、早产、产后出血、血栓栓塞性疾病、死亡的发生率差异无统计学意义。(3)4组新生儿畸形、颅内出血、死亡的发生率差异无统计学意义。结论:无血栓形成高危因素的主动脉瓣机械瓣置换术后患者妊娠期使用华法林安全有效。Objective:To explore and discuss the anticoagulant therapy throughout pregnancy in patients with mechanical aortic valve replacement.Methods:120 pregnant patients after mechanical aortic valve replacement were randomly divided into 4 groups according to different anticoagulant therapy projects from January 2013 to January 2017.Patients in the group A were given oral domestic warfarin throughout pregnancy,and those in the group B were given the low molecular weight heparins calcium injection and then oral domestic warfarin after 12 weeks of pregnancy,and those in the group C were given oral imported warfarin throughout pregnancy,and those in the group D were given the low molecular weight heparins calcium injection and then oral imported warfarin after 12 weeks of pregnancy.The administration of warfarin was controlled aiming for an international normalized ratio of 1.5 to 2.0.Results:(1) There was significant difference on the warfarin dose between group C/D and group A/B.(2) There was no significant difference on the incidence of spontaneous abortion,premature delivery,postpartum hemorrhage,thrombotic complication and death between 4 groups.(3) There was no significant difference on the incidence of neonatal abnormality,intracranial hemorrhage and death between 4 groups.Conclusions:Oral warfarin throughout pregnancy in patients without high risk factors of thrombosis after mechanical aortic valve replacement is safe and effective.

关 键 词：主动脉瓣置换术 机械瓣 妊娠 华法林 

分 类 号：R654.2[医药卫生—外科学]