發(fā)布時(shí)間：2019-04-19 07:43

【摘要】：目的:通過對(duì)我院心臟機(jī)械瓣膜置換術(shù)后患者抗凝強(qiáng)度及抗凝相關(guān)并發(fā)癥進(jìn)行隨訪研究,為我國(guó)制定安全有效的心臟機(jī)械瓣膜置換術(shù)后抗凝強(qiáng)度標(biāo)準(zhǔn)提供依據(jù),為臨床抗凝治療提供參考。方法:根據(jù)嚴(yán)格的納入排除標(biāo)準(zhǔn),納入2014年1月至2016年10月于山西醫(yī)科大學(xué)第一醫(yī)院心胸外科行心臟機(jī)械瓣膜置換術(shù)后使用華法林抗凝治療的患者162例。對(duì)研究對(duì)象的術(shù)后抗凝強(qiáng)度及抗凝相關(guān)并發(fā)癥進(jìn)行隨訪。根據(jù)抗凝強(qiáng)度高低將研究對(duì)象分為A、B兩組。統(tǒng)計(jì)分析A組與B組抗凝相關(guān)并發(fā)癥的發(fā)生率是否存在差異。對(duì)未出現(xiàn)并發(fā)癥病例的抗凝強(qiáng)度進(jìn)行統(tǒng)計(jì)學(xué)分析,得出安全有效的抗凝強(qiáng)度范圍。結(jié)果:隨訪患者3~34個(gè)月,共納入162例患者,共發(fā)生出血11例(6.79%),其中腦出血1例(0.62%),消化道出血1例,鼻出血3例,牙齦出血6例;血栓栓塞共3例(1.85%),其中腦梗塞1例,右下肢動(dòng)脈栓塞2例。A組共103例,其中出血2例(1.94%),血栓栓塞3例(2.91%),B組共59例,其中出血9例(15.25%),血栓栓塞0例(0.00%)。A組與B組PT值及INR值之間均存在統(tǒng)計(jì)學(xué)差異(P0.05)。A組比B組抗凝相關(guān)并發(fā)癥的發(fā)生率低且有統(tǒng)計(jì)學(xué)差異(P0.05)。A組比B組出血并發(fā)癥的發(fā)生率低且有統(tǒng)計(jì)學(xué)差異(P0.05)。A組與B組血栓栓塞(TE)并發(fā)癥的發(fā)生率無統(tǒng)計(jì)學(xué)差異(P0.05)。二尖瓣膜置換術(shù)后華法林抗凝治療,A組與B組抗凝相關(guān)并發(fā)癥的發(fā)生率無統(tǒng)計(jì)學(xué)差異(P0.05),A組比B組抗凝相關(guān)出血的發(fā)生率低且有統(tǒng)計(jì)學(xué)差異(P0.05),而抗凝相關(guān)血栓栓塞的發(fā)生率無統(tǒng)計(jì)學(xué)差異(P0.05)。二尖瓣置換(MVR)與主動(dòng)脈瓣置換(AVR)、二尖瓣置換(MVR)與雙瓣置換(DVR)、主動(dòng)脈瓣置換(AVR)與雙瓣置換術(shù)(DVR)后抗凝相關(guān)并發(fā)癥的發(fā)生率均無統(tǒng)計(jì)學(xué)差異。心臟機(jī)械瓣膜置換術(shù)后華法林抗凝治療PT值的安全范圍是19.32~26.6s,INR值的安全范圍是1.55~2.2。結(jié)論:心臟機(jī)械瓣膜置換術(shù)后較低強(qiáng)度抗凝治療能降低出血發(fā)生率,且不增加血栓栓塞發(fā)生率,故較低強(qiáng)度抗凝是可行的。本研究得出心臟機(jī)械瓣膜置換術(shù)后華法林抗凝治療的PT安全范圍是19.32~26.6s,INR安全范圍是1.55~2.2。
[Abstract]:Objective: through the follow-up study on anticoagulation intensity and related complications of patients after mechanical valve replacement in our hospital, to provide the basis for establishing a safe and effective standard of anticoagulation strength after mechanical valve replacement in our country. It provides reference for clinical anticoagulation therapy. Methods: from January 2014 to October 2016, 162 patients who were treated with warfarin anticoagulation after mechanical heart valve replacement were included according to the strict inclusion exclusion criteria in the Department of Cardiothoracic surgery of the first Hospital of Shanxi Medical University from January 2014 to October 2016. The postoperative anticoagulation intensity and anticoagulation related complications were followed up. According to the level of anti-coagulation strength, the subjects were divided into two groups: group A and group B. The incidence of anticoagulation-related complications between group A and group B was statistically analyzed. A safe and effective range of anticoagulation strength was obtained by statistical analysis of anticoagulation intensity in patients without complications. Results: a total of 162 patients were included in the follow-up for 34 months. There were 11 cases (6.79%) of hemorrhage, including 1 case of cerebral hemorrhage (0.62%), 1 case of gastrointestinal bleeding, 3 cases of nosebleed and 6 cases of gingival bleeding. There were 3 cases (1.85%) of thromboembolism, including 1 case of cerebral infarction and 2 cases of arterial embolism of the right lower extremities. Group A consisted of 103 cases, of which 2 cases (1.94%) were bleeding, 3 cases (2.91%) were thromboembolism, 59 cases were in group A (2.91%), B). Of these, 9 (15.25%) had bleeding. There was a significant difference in PT and INR between 0 cases of thromboembolism (0.001%). A group and B group) (P 0.05). A group was lower than B group in the incidence of anticoagulation-related complications (P0.05). A). The incidence of bleeding complications in group B was lower than that in group B (P 0.05). There was no significant difference in incidence of (TE) complications between group). A and group B (P0.05). There was no significant difference in the incidence of anticoagulation-related complications between group A and group B after valvular replacement with warfarin (P0.05). The incidence of anticoagulation-related bleeding in group), A was significantly lower than that in group B (P0.05), and there was no significant difference between group A and group B (P0.05). There was no significant difference in the incidence of anticoagulation-associated thromboembolism (P0.05). There was no significant difference between mitral valve replacement (MVR) and aortic valve replacement (AVR), mitral valve replacement (MVR) and double valve replacement (DVR), aortic valve replacement (AVR) and anticoagulation related complications after double valve replacement after (DVR). The safety range of warfarin anticoagulant therapy after mechanical heart valve replacement is 19.32? 26.6s, and the safe range of INR is 1.55? 2.2.The safety range of warfarin anticoagulation is 19.32? 26.6s and 1.55? 2.2. Conclusion: low intensity anticoagulation therapy can reduce the incidence of bleeding and not increase the incidence of thromboembolism after mechanical valve replacement, so it is feasible to use low intensity anticoagulation therapy. In this study, the safety range of warfarin anticoagulant therapy after mechanical heart valve replacement was 19.32? 26.6s, and the safe range of PT was 1.55? 2.2.The safety range of warfarin was 19.32? 26.6s and 1.55? 2.2.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R654.2

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