单叶和双叶机械瓣置换术后抗凝治疗的临床对比  

A clinical comparative study on effects of anticoagulation therapy for the patients implanted unileaflet or bileaflet mechanical prosthetic valves

作　　者：张春曦[1] 黄达德[1] 

机构地区：[1]广州市第一人民医院心胸外科,广州市510180

出　　处：《岭南心血管病杂志》2004年第1期35-37,共3页South China Journal of Cardiovascular Diseases

摘　　要：目的　通过对单叶和双叶机械瓣置换术后抗凝相关并发症的对比研究 ,探讨在相同的抗凝强度下 ,两者存在的差异。方法　按标准选取 2 14例机械瓣置换术后患者作为研究对象 ,其中接受双叶瓣者 118例 (CarboMedics 82例 ,St Jude 36例 )作为A组 ,单叶瓣者 96例 (兰州瓣 4 1例 ,上海瓣 5 5例 )作为B组。均应用口服华法林 (芬兰产 )抗凝 ,用量 0 75～ 4 0 0mg[(1 94± 1 16 )mg],控制INR 1 5～2 3。随诊 3～ 84个月 [平均 (39 86± 16 2 8)个月 ],比较出血和栓塞的发生率。结果　 2 14名患者 11例发生出血 ,其中A组 6例 ,B组 5例。栓塞 9例 ,A组 1例 ,B组 8例。结论　INR控制在 1 5～ 2 3可有效地预防双叶瓣术后抗凝相关并发症 ,对单叶瓣可有效地预防出血 ,但栓塞的风险明显增高。Objectives We sought to compare the effects of anticoagulation therapy on the patients with unileaflet or bileaflet mechanical prosthetic valve (MPV) associated with identity intensity of anticoagulation. Methods 214 patients were evaluated for eligibility to enter the trial: 118 patients received bileaflet MPV (CarboMedics, St.Jude.group A) and 96 patients received unileaflet MPV (Lanzhou, Shanghai. group B). Anticoagulation with oral warfarin (Espoo product) was at an INR range 1.5～2.3 for each patients, warfarin dose range was 0.75～4 mg/day [mean (1.94±1.16) mg/day]. Follow-up study were performed on all patients during 3～84 months [mean (39.86±16.28) months]. The rates of thrombembolic and anticoagulation associated bleeding were compared. Results 6 patients in the group A and 5 patients in the group B had bleeding complication events. 1 patient in the group A and 8 patients in the group B had thrombembolic events. Conclusions An INR of 1.5～2.3 is recommended to protect patients who recipiented bileaflet MPV form developing a complication of bleeding or thrombembolia. However, the risk of thrombembolia would be increased in the patients who recipiented unileaflet.

关 键 词：单叶机械 双叶机械瓣 术后并发症 抗凝治疗 瓣膜置换术 心脏手术 

分 类 号：R654.2[医药卫生—外科学]