心脏瓣膜置换术后抗凝栓塞并发症研究  

Complications of anticoagulant embolism aftercardiac valve replacement

作　　者：王吉显 王斌[1] 徐平[1] 杨苏民[1] 高洪波[1] 李贞福[1] 隋玉龙[1] 常青[1] 

机构地区：[1]青岛大学附属医院心血管外科,山东青岛266000

出　　处：《临床军医杂志》2018年第1期54-56,共3页Clinical Journal of Medical Officers

摘　　要：目的对心脏瓣膜置换手术后应用华法林抗凝出现栓塞并发症的情况进行随访,分析不同瓣膜置换及心房颤动对栓塞并发症发生情况的影响。方法对2012年1月1日至2014年12月31日期间于青岛大学附属医院心血管外科出院的行心脏瓣膜置换术的888例患者进行随访,记录其服用抗凝药物、出现栓塞并发症及病死的情况。根据置换瓣膜及心房颤动发生情况分为机械瓣组(机械瓣伴心房颤动组、机械瓣无心房颤动组)、生物瓣组(生物瓣伴心房颤动组、生物瓣无心房颤动组)、心房颤动组及无心房颤动组,统计各组患者栓塞并发症人次,计算并比较栓塞发生率(%/年)。结果完成随访患者共803例,随访率90.43%,排除31例术后院内病死患者,共纳入772例患者,随访2 590.59人年(0.18~5.00人年)。纳入患者总栓塞并发症26人次(1.00%/年)。机械瓣组栓塞13人次(1.08%/年),生物瓣组栓塞13人次(0.94%/年),组间比较,差异无统计学意义(P>0.05)。机械瓣伴心房颤动组栓塞8人次(1.57%/年),生物瓣伴心房颤动组栓塞10人次(2.12%/年),组间比较,差异无统计学意义(P>0.05)。心房颤动组栓塞18人次(1.83%/年),无心房颤动组栓塞8人次(0.50%/年),组间比较,差异有统计学意义(P<0.01)。机械瓣伴心房颤动组栓塞8人次(1.57%/年),机械瓣无心房颤动组栓塞5人次(0.72%/年),组间比较,差异无统计学意义(P>0.05)。生物瓣伴心房颤动组栓塞10人次(2.12%/年),生物瓣无心房颤动组栓塞3人次(0.33%/年),组间比较,差异有统计学意义(P<0.01)。结论机械瓣与生物瓣在瓣膜置换术后对患者栓塞的发生率无明显影响,但对于合并心房颤动患者,栓塞发生率高。Objective To investigate the complications of anticoagulant embolism induced by Warfarin after cardiac valve replacement,and analyze the effects of different valve replacement and atrial fibrillation（ AF）. Methods A retrospective study was performed on 888 cases of patients who underwent cardiac valve replacement from January 1 st,2012 to December 31 th,2014. Anticoagulant drug use,complications of embolismand mortalitywere recorded. According to types of valve prostheses and AF status,patients were divided into the mechanical valve group（ mechanical valve with AF group,mechanical valve without AF group）,bioprosthesis valve group（ bioprosthesis valve with AF group,bioprosthesis valve without AF group）,AF group and non-AF group,the incidence of thromboembolism was calculated and compared with the patients in each group（ %/year）. Results Follow-up was completed in 803 cases,with a follow-up rate 90. 43%. Thirty-one patients who died during post-operative hospitalization were excluded and the remaining 772 patients were included. There were a total of 2 590. 59 person-years（ 0. 18 ~ 5. 00 person-years） of follow-up. The number of embolism complications was 26 person-times（ 1. 00%/year）. There were 13 person-times（ 1. 08%/year） of embolism in the mechanical valve group,13 person-times（ 0. 94%/year） of embolism in the bioprosthesis valve group,and there was no statistically significant difference between the two groups（ P 〉 0. 05）. There were 8 person-times（ 1. 57%/year） of embolism in the mechanical valve with AF group,10 person-times（ 2. 12%/year） of embolism in the bioprosthesis valve with AF group,and there was no statistically significant difference between the two groups（ P 〉 0. 05）. There were 18 person-times（ 1. 83%/year） of embolism in AF group,8 person-times（ 0. 50%/year） of embolism in non-AF group,and there was statistically significant difference between the two groups（ P 〈 0. 01）.There were 8 person-times（ 1. 57%/year） of embolism in m

关 键 词：心脏瓣膜置换 栓塞 机械瓣 生物瓣 

分 类 号：R654.2[医药卫生—外科学]