二尖瓣机械瓣膜置换术后不同阶段华法林剂量调整策略研究  

Study on warfarin dose adjustment strategy at different stages after mechanical valve replacement of mitral valve

作　　者：陈黎 陈赛 李涛[1] 赵婷婷[1,2] 童琪 钱永军 CHEN Li;CHEN Sai;LI Tao;ZHAO Tingting;TONG Qi;QIAN Yongjun(Department of Cardiovascular Surgery,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;West China School of Nursing,Sichuan University,Chengdu,610041,P.R.China)

机构地区：[1]四川大学华西医院心脏大血管外科,成都610041 [2]四川大学华西护理学院,成都610041

出　　处：《中国胸心血管外科临床杂志》2021年第8期945-953,共9页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家老年疾病临床医学研究中心(四川大学华西医院)立项资助课题(Z2018B19)。

摘　　要：目的研究二尖瓣机械瓣膜置换术后不同阶段华法林剂量调整策略。方法回顾性分析2013~2017年在中国成人心脏外科数据库内行二尖瓣机械瓣膜置换术的302例患者临床资料,其中男76例、女226例,平均年龄(50.1±10.1)岁。根据服用华法林的剂量调整策略,将患者分为D组(以天为单位调整华法林剂量)和W组(以周为单位调整华法林剂量),评价华法林抗凝效果。结果总随访时间为423 277 d(1 159.7年)。在抗凝强度效果方面,总体上无差异,术后早期(术后≤6个月)以天为单位调整华法林剂量更好(P<0.05),年龄>60岁的患者尤为明显;术后中期(术后6~24个月)、术后长期(术后≥24个月)以周为单位调整华法林剂量更好(P<0.05),长期以年龄≤40岁的患者尤为明显。在抗凝效果稳定性方面,总体上短期内以周为单位调整华法林剂量更好(P<0.05);术后早、中、长期抗凝治疗的短期内以周为单位调整华法林剂量更好(P<0.05),以女性、年龄>40且≤50岁患者尤为明显。结论在目标国际标准化比值范围(1.5~2.5)内,行二尖瓣机械瓣膜置换术的患者术后早期以天为单位调整华法林剂量的抗凝策略能取得更好的抗凝强度效果,而术后中、长期以周为单位调整华法林剂量的抗凝策略更好。总体上以周为单位调整华法林剂量的抗凝策略在短期内的抗凝效果相对更稳定。Objective To explore the anticoagulant strategy of adjusting the dose of warfarin at different stages after mechanical valve replacement of mitral valve.Methods Clinical data of a total of 302 patients,including 76 males and 226 females,with an average age of 50.1±10.1 years,who underwent mechanical mitral valve replacement in the Chinese adult cardiac surgery database from 2013 to 2017 were retrospectively analyzed.According to the dose adjustment strategy of taking warfarin,the patients were divided into a D group(adjusting warfarin dose in days)and a W group(adjusting warfarin dose in weeks)to evaluate the anti-coagulation effect of warfarin.Results The total follow-up time was 423277 d(1159.7 years).There was no significant difference in the overall anticoagulant strength,and the warfarin dose adjusted in days was better in the early postoperative period(P<0.05),especially in patients over 60 years.It was better to adjust warfarin dose in weeks in the middle and long periods(P<0.05),especially in patients≤40 years.In terms of the stability of anticoagulation,it was better to adjust the dosage of warfarin in weeks(P<0.05).It was better to adjust the dosage of warfarin in weeks for early,middle-and long-term anticoagulant therapy after operation(P<0.05),especially in the females aged>40 and≤50 years.Conclusion Within the target range of international normalized ratio(1.5-2.5),the anticoagulant strategy of adjusting warfarin dose in days after mechanical valve replacement of mitral valve can achieve a better anticoagulant strength,and adjusting the dosage of warfarin in weeks is better in the middle-and long-term after operation.In general,the anticoagulant effect is more stable in the short term when warfarin dose is adjusted on a weekly basis.

关 键 词：华法林 二尖瓣机械瓣膜置换术 抗凝治疗 国际标准化比值 治疗范围时间 治疗范围时间分数 

分 类 号：R654.2[医药卫生—外科学]