MHVR合并CABG手术患者术后不同抗凝方案的效果及不良终点事件观察  

Observation of the effects and adverse end-points of different anticoagulation regimens in patients with MHVR combined with CABG surgery

作　　者：吕海玉 项梅[1] 林慧君 杨秋喜 余成[1] 任建立[3] LYU Hai-yu;XIANG Mei;LIN Hui-jun(Department of Cardiac Surgery,Hainan Provincial People's Hospital,Haikou Hainan 570311,China)

机构地区：[1]海南省人民医院心脏外科,海南海口570311 [2]海南医学院第一附属医院肝胆外科,海南海口570102 [3]延安大学附属医院心血管外科,陕西延安716000

出　　处：《临床和实验医学杂志》2022年第10期1049-1053,共5页Journal of Clinical and Experimental Medicine

基　　金：海南省医药卫生科研项目(编号:18A180570)。

摘　　要：目的探讨心脏机械瓣膜置换(MHVR)联合冠状动脉搭桥术(CABG)患者术后采用不同的抗凝治疗方案的效果差异及不良终点事件观察。方法前瞻性选取海南省人民医院2017年2月1日至2021年1月31日实施MHVR联合CABG手术治疗的患者80例作为研究对象,根据随机数字表法分为A组、B组,各40例。A组给予阿司匹林+华法林方案抗凝,B组给予单用华法林抗凝。对比两组患者的血小板数量、血小板聚集性变化,患者的华法林用量、国际标准化比值(INR)达标时间及控制率等指标,并对比两组不良事件发生率及生存时间。结果两组患者在术前至术后6个月的血小板计数比较,差异均无统计学意义(P>0.05);两组患者在术后7 d、术后30 d、术后6个月的血小板计数值较本组术前、术后2 d均显著升高,差异均有统计学意义(P<0.05)。在术后30 d、术后6个月时,A组患者的二磷酸腺苷5μmol/L血小板聚集性测定值、二磷酸腺苷10μmol/L血小板聚集性测定值均显著低于B组患者,差异均有统计学意义(P<0.05)。两组患者的华法林用量、INR<1.5占比情况比较,差异无统计学意义(P>0.05);A组患者的INR首次达到目标时间、INR>2.2占比情况为(4.52±0.77)d、(9.29±2.68)%,低于B组[(4.97±0.84)d、(10.61±2.94)%],A组患者的最佳INR控制率为(49.63±5.74)%,高于B组[(46.24±6.00)%],差异均有统计学意义(P<0.05)。随访1年,A组患者的不良事件发生率为15.00%,B组患者为7.50%,差异无统计学意义(P>0.05)。A组与B组患者的无不良事件发生生存时间比较,差异无统计学意义(P>0.05)。结论MHVR联合CABG手术的患者采用阿司匹林+华法林方案实施抗凝治疗,对于降低血小板聚集性,能早期达到抗凝标准,同时不会增大患者的不良事件发生率及影响患者不良事件生存时间。Objective To explore the difference in the effect of different anticoagulant treatments and the observation of adverse end-points in patients with mechanical heart valve replacement(MHVR)combined with coronary artery bypass graft(CABG)surgery.Methods A total of 80 patients who underwent MHVR combined with CABG surgery in Hainan Provincial People's Hospital from February 1,2017 to January 31,2021 were prospectively selected as the research subjects,and they were divided into group A and group Baccording to the random number table method,40 cases in each group.Group A was given aspirin+warfarin anticoagulation,and group B was given warfarin alone.The platelet count,platelet aggregation changes,warfarin dosage,international normalized ratio(INR)time and control rate of the patients were compared between the two groups,and the adverse events of incidence and associated median time were compared between the two groups.Results There was no significant difference in platelet count between groups A and B from preoperative to 6 months after operation(P>0.05).Monthly platelet counts were significantly higher than those in this group before operation and 2 days after operation,and the differences were statistically significant(P<0.05).The measured value of 5μmol/L platelet aggregation and the measured value of 10μmol/L adenosine diphosphate were significantly lower than those in group B,and the differences were statistically significant(P<0.05).There was no significant difference in forest dosage and proportion of INR<1.5(P>0.05);the INR of group A patients reached the target time for the first time and the proportion of INR>2.2 were(4.52±0.77)d,(9.29±2.68)%,which were lower than that of group B[(4.97±0.84)d,(10.61±2.94)%],and the best INR control rate of patients in group A was(49.63±5.74)%,which was higher than that of group B[(46.24±6.00)%],and the differences were statistically significant(P<0.05).After 1 year of follow-up,the incidence of adverse events in group A was 15.00%,and that in group B was 7.50%,and th

关 键 词：心脏机械瓣膜置换 冠状动脉搭桥术 阿司匹林 华法林方案 抗凝 不良终点事件 

分 类 号：R654.2[医药卫生—外科学]