心脏瓣膜置换术后发生心包积液抗凝治疗的研究  

Anticoagulant Therapy in Patients with Pericardial Effusion After Cardiac Valve Replacement

作　　者：张欢[1] 杨桂玲[1] 高义玲[1] 赵牡丹 ZHANG Huan;YANG Guiling;GAO Yiling;ZHAO Mudan(Nanjing Tongren Hospital,School of Medicine of Southeast University,Jiangsu Nanjing 211102,China)

机构地区：[1]东南大学医学院附属南京同仁医院,江苏南京211102

出　　处：《中国医药导刊》2021年第5期321-324,共4页Chinese Journal of Medicinal Guide

摘　　要：目的:探讨心脏瓣膜置换术后发生心包积液时的抗凝治疗策略。方法:选取2018年1月至2020年12月在我院心胸外科住院的心脏瓣膜置换术后发生心包积液的15例患者为研究对象,对发生心包积液的原因、处理、恢复抗凝时机进行分析。结果:15例心脏瓣膜置换术后心包积液的患者,除行心包穿刺引流术外,均停用华法林抗凝治疗,并予维生素K 1注射液抗凝逆转处理,在12 h后移除引流导管,移除引流管后12~24 h重启抗凝治疗,平均国际标准化比值(INR)控制在1.5~2.0。所有患者重启抗凝治疗后随访3个月内均未发生心包积液、血栓栓塞事件。结论:患者若在心脏瓣膜置换术后发生心包积液,应停用抗凝药物,综合评估患者血栓及再出血的风险,决定重启抗凝治疗时机;此外,适当降低抗凝强度,以减少患者再次发生心包积液的风险。Objective:To investigate the anticoagulant therapy in patients with pericardial effusion after cardiac valve replacement.Methods:A total of 15 patients with pericardial effusion after cardiac valve replacement who were hospitalized in the department of cardiothoracic surgery of our hospital from January 2018 to December 2020 were selected as the research objects.The causes,management and anticoagulant therapy recovery time of pericardial effusion were analyzed.Results:15 patients with pericardial effusion after cardiac valve replacement,in addition to pericardium puncture drainage,were discontinued warfarin anticoagulant therapy,and given vitamin K 1 injection anticoagulant reversal therapy.The drainage catheter was removed 12 h later,anticoagulant therapy was resumed 12-24 h after removal of the drainage catheter,and INR was controled in 1.5-2.0.There was no pericardial effusion and thromboembolic events in patients after following up for 3 months.Conclusion:If patients occur pericardial effusion after cardiac valve replacement,anticoagulants should be discontinued,and the risk of thrombosis and rebleeding should be comprehensively assessed to determine the timing of restarting anticoagulant therapy.In addition,the anticoagulant strength should be appropriately reduced to reduce the risk of recurrent pericardial effusion.

关 键 词：心脏瓣膜置换术 抗凝治疗 心包积液 

分 类 号：R473.6[医药卫生—护理学]