一种新型心室辅助装置植入术后抗凝治疗管理  

Management of anticoagulant therapy after implantation of a new ventricular assist device

作　　者：刘天文[1] 刘晓程[1] 韩志富 刘志刚[1] 陈铁男[1] 李军[1] 许剑 王帆[1] 赵廷彪 张杰民[1] LIU Tianwen;LIU Xiaocheng;HAN Zhifu;LIU Zhigang;CHEN Tienan;LI Jun;XU Jian;WANG Fan;ZHAO Tingbiao;ZHANG Jiemin(TEDA International Cardiovascular Hospital,Tianjin 300457,China;Rocket Heart Technology Co.Ltd,Tianjin 300457)

机构地区：[1]泰达国际心血管病医院,天津300457 [2]航天泰心科技有限公司,天津300457

出　　处：《中国比较医学杂志》2019年第7期86-91,共6页Chinese Journal of Comparative Medicine

基　　金：国家重点研发计划<有源植入人工器官质量评价方法和平台研究>(2016YFC0103203)

摘　　要：目的通过对左心辅助羊术后抗凝的药物管理,摸索行之有效的抗凝治疗方案。方法6例雄性成年绵羊,(80.0±5.0)kg,分别植入同一型号的左心室辅助装置(left ventricular assist device,LVAD)。术后前2周,每日清晨采血1次;之后,每周采晨血1次。术后每日口服华法林,检测凝血全项,持续观察10周,对抗凝效果做出评价。结果6例实验动物的生理状态下的国际标准化比率(international normalized ratio,INR)为1.265±0.146,活化部分凝血活酶时间(activated partial thromboplastin time,APTT)为(41.017±12.530)s,乳酸脱氢酶(lactate dehydrogenase,LDH)为(411±119)U/L。术后1~3 d,应用肝素和口服华法林,控制INR和APTT分别为基值的1.4和1.7倍。待实验动物可以平稳进食后,停止使用肝素。持续监测INR,调整华法林用量。术后2周内,使用华法林(7.96±5.45)mg/d,测得INR为1.89±0.53。术后10周内,使用华法林(11.44±7.80)mg/d,测得INR为2.01±0.91;LDH为(509±92)U/L。在研究过程中,6例HeartCon均未出现泵内血栓,实验动物未见消化道出血等迹象。结论术后早期应用肝素抗凝是必要的。在不改变饮食结构的前提下,两周内基本可以制定每例个体的抗凝治疗标准。单一使用华法林,可以达到预期的抗凝效果。Objective To determine an effective anticoagulant treatment program by the management of anticoagulants after the implantation of a new left ventricular assist device(LVAD)in sheep.Methods Six male healthy sheep weight 80±5 kg were implanted with the same type of LVAD.Blood was collected once a day in the first two weeks and once a week thereafter.The sheep were observed and evaluated for 10 weeks.Results The physiological state of the six experimental animals:the international normalized ratio(INR)was 1.265±0.146;activated partial thromboplastin time(APTT)was 41.017±12.530 s;lactate dehydrogenase(LDH)level was 411±119 U/L.One to three days after operation,the control of INR and APTT by heparin and warfarin were 1.4 and 1.7 times higher.Heparin was stopped when the animal could eat again.INR was monitored continuously and the warfarin dosage was adjusted.Two weeks after operation,warfarin 7.96±5.45 mg/d was used and the INR was 1.89±0.53.Ten weeks after operation,warfarin 11.44±7.80 mg/d was used,the INR was 2.01±0.91 and the level of LDH was 509±92 U/L.During the study,no thrombus caused by the pump was found,and no gastrointestinal bleeding was found in experimental animals.Conclusions It is necessary to apply heparin early after the operation.Under the premise of not changing the diet structure,the anticoagulant treatment standard for each individual is established within 2 weeks.The use of warfarin only can achieve the expected anticoagulant effect.

关 键 词：心力衰竭 心室辅助装置 血栓形成 抗凝剂 绵羊 

分 类 号：R-33[医药卫生]