香豆素类相关获得性维生素K依赖性凝血因子缺乏症的临床分析  

Clinical analysis of coumarins associated acquired vitamin K-dependent coagulation factor deficiency

作　　者：吴诗馨[1] 黄月琴[1] Wu Shixin;Huang Yueqin(Department of Hematology,Donghai Branch,The Second Affiliated Hospital of Fujian Medical University,Quanzhou 362000,China)

机构地区：[1]福建医科大学附属第二医院东海院区血液科,泉州362000

出　　处：《国际医药卫生导报》2022年第24期3551-3554,共4页International Medicine and Health Guidance News

摘　　要：目的探讨香豆素类(包括华法林过量和毒鼠药中毒)相关获得性维生素K依赖性凝血因子缺乏症的临床特点和治疗效果。方法回顾性分析2013年7月至2022年7月福建医科大学附属第二医院东海院区血液科诊治的61例患者临床资料,根据香豆素类类型分为A组(华法林过量,34例)和B组(香豆素类鼠药中毒,27例)。A组男19例、女15例,年龄32~82岁(中位年龄71岁);B组男15例、女12例,年龄19~88岁(中位年龄53岁)。出血症状严重者给予静脉滴注维生素K_(1)10~60 mg/d,辅以输注新鲜冰冻血浆。比较治疗前后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)变化及维生素K_(1)解毒时间。采用t检验。结果A组华法林过量伴出血表现患者维生素K_(1)治疗前PT[(111.58±46.50)s]、APTT[(100.02±20.58)s]与治疗后PT[(17.13±4.30)s]、APTT[(37.77±58.91)s]比较,差异均有统计学意义(均P<0.01);华法林过量无出血表现患者仅需暂停华法林。B组香豆素类鼠药中毒患者维生素K_(1)治疗前PT[(102.13±75.34)s]、APTT[(84.02±48.24)s]与治疗后PT[(17.39±4.43)s]、APTT[(33.03±7.78)s]比较,差异均有统计学意义(均P<0.01)。华法林过量伴出血表现患者维生素K_(1)解毒时间1 d,香豆素类鼠药中毒患者维生素K_(1)解毒时间1个月至1年,两者维生素K_(1)解毒时间不同(P<0.01)。结论华法林、香豆素类鼠药均属于香豆素类抗凝剂,其用药过量或中毒,维生素K_(1)治疗均有效;因为2种药物使用目的及半衰期不同,故两者过量后的解毒方式不尽相同。Objective To investigate the clinical characteristics and therapeutic effect of acquired vitamin K dependent coagulation factor deficiency caused by coumarins including overdosage of warfarin and rodenticide poisoning.Methods The clinical data of 61 patients diagnosed in Department of Hematology,Donghai Branch,The Second Affiliated Hospital of Fujian Medical University from July 2013 to July 2022 were retrospectively analyzed.According to the type of coumarins,they were divided into group A(overdosage of warfarin,34 cases)and group B(rodenticide poisoning,27 cases).There were 19 males and 15 females in group A,aged 32-82 years,with a median age of 71 years old;in group B,there were 15 males and 12 females,aged 19-88 years,with a median age of 53 years old.The patients with severe bleeding symptom were given intravenous infusion of vitamin K_(1)10-60 mg/d supplemented with infusion of fresh frozen plasma.The changes of prothrombin time(PT)and activated partial thromboplastin time(APTT)before and after treatment and the detoxification time of vitamin K_(1) were detected.t test was used.Results The patients with overdosage of warfarin and bleeding in group A showed PT(111.58±46.50)s and APTT(100.02±20.58)s before vitamin K_(1) treatment,and PT(17.13±4.30)s andAPTT(37.77±58.91)s after vitamin K_(1) treatment,with statistically significant differences(both P<0.01);warfarin should be suspended only in patients without bleeding.The patients with rodenticide poisoning in group B showed PT(102.13±75.34)s and APTT(84.02±48.24)s before vitamin K_(1) treatment,and PT(17.39±4.43)s and APTT(33.03±7.78)s after vitamin K_(1) treatment,with statistically significant differences(both P<0.01).The detoxification time of vitamin K_(1) in patients with overdosage of warfarin and bleeding was 1 day,and 1 month to 1 year in patients with rodenticide poisoning,and the detoxification time of vitamin K_(1) was different between the two(P<0.01).Conclusions Warfarin and rodenticide are coumarin anticoagulants.Vitamin K_(1) is effecti

关 键 词：香豆素类 获得性维生素K依赖性凝血因子缺乏症 华法林 毒鼠药 维生素K_(1) 凝血酶原时间 活化部分凝血活酶时间 

分 类 号：R554.7[医药卫生—血液循环系统疾病]