人工机械瓣膜置换术后的抗凝药物治疗分析  

Analysis of Warfarin Anticoagulation Therapy for Patients after Undergoing Mechanical Valve of Heart Replacement Surgery

作　　者：孙慧萍 王来成 唐会卓 张波 Sun Huiping;Wang Laicheng;Tang Huizhuo;Zhang Bo(Department of Pharmacy, the Traditional Chinese medicine Hospital of Fengxian, Xuzhou 221700, China;Department of Pharmacy, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China)

机构地区：[1]丰县中医医院药剂科,徐州221700 [2]徐州医科大学附属医院药学部,徐州221006

出　　处：《北方药学》2019年第3期189-191,共3页Journal of North Pharmacy

摘　　要：目的:对本院2015年1月～2017年12月93例人工机械瓣膜置换术后患者应用华法林进行低强度抗凝药物治疗的安全性和有效性进行分析和评价,优化机械瓣膜置换术后抗凝药物治疗管理。方法:利用我院HIS系统检索收集胸外科行人工机械瓣膜置换术病例。对不同机械瓣膜类型抗凝药物治疗进行统计,分析术后华法林抗凝用药情况、凝血功能(PT、INR)及抗凝治疗期间出现的出血和栓塞事件。结果:在MVR(包括DVR)患者中,术后第三月华法林剂量为(3.00±2.46)mg/d,INR值2.11±0.52;在AVR患者中,术后第三月华法林剂量为(3.11±1.91)mg/d,INR值2.08±0.33。MVR(包括DVR)术后,其中有52例(82.54%)的抗凝强度在目标范围内;AVR术后有24例(80%)抗凝强度在目标范围内。16例抗凝用药期间发生出血反应,发生率17.20%,2例栓塞反应,发生率为2.15%。结论:机械瓣膜置换术后华法林抗凝效果个体差异较大,抗凝效果约在2～4周内达到稳定;本院人工机械瓣膜置换术后进行低强度抗凝药物治疗是安全和有效的;临床药师根据患者特点,给予全程药学监护和抗凝出血风险管控,并通过抗凝门诊对出院患者进行系统化管理,可提高抗凝药物治疗的有效性和安全性。Objective: To analyze and evaluate the safety and efficacy of low-intensity anticoagulant therapy with warfarin after artificial mechanical valve replacement in our hospital from 2015.01 to 2017.12, and to optimize management of anticoagulation therapy. Methods: Using the HIS system of hospital to retrieve and collect cases of thoracic surgery artificial mechanical valve replacement patients from 2015.01to2017.12. Statistically analyzing how the anticoagulant drug treatments was performed after the repacement of different mechanical valve. Results: Among the patients with MVR(including DVR), the dose of warfarin was 3.00 ±2.46mg every day, and INR value was 2.11± 0.52 after three monthes of the operation. Among the patients with AVR, the dose of warfarin was 3.11 ± 1.91mg every day and the INR was 2.08±0.33. In MVR(including DVR), 52 cases(82.54%)of the anticoagulant strength within the expected allowable range;In AVR , there were 24 cases(80%)of the anticoagulant strength within the expected allowable range. In the course of the anticogulation therapy, the bleeding cases accounted for 17.2%, and that of embolism cases was 2.15%. Conclusions: After the use of mechanical valve replacement, warfarin had greater individual differences, and the anticoagulant effect was stable within 2~4 weeks. For most patients after artificial valve replacement in this hospital low strength anticoagulation therapy was both safe and effective. Clinical pharmacists gived full control of the risk of drug using and anticoagulant bleeding according to patient characteristics, and systematic management through anticoagulation clinics could further improve the effectiveness and safety of anticoagulant therapy.

关 键 词：人工机械瓣膜置换术 华法林 低强度抗凝 

分 类 号：R969.3[医药卫生—药理学]