摘要
【目的】探讨机械瓣膜替换术后适宜的抗凝程度时最佳国际标准化比值(internationalnormalizedratio,INR)。【方法】对我院从2000年4月至2002年4月收治40例瓣膜替换术后应用华法令抗凝治疗患者进行了前瞻性的临床研究。所在患者均应用CarboMedics双叶瓣行人瓣膜替换术。术后24h开始每天服华法令3mg,每天测定INR值,连测14次,出院后临床随访1～2年,按研究计划测定INR值共14次。同时观察指标包括与抗凝有关的出血、血栓、栓塞和死亡等情况。【结果】本组患者口服华法令3～5d后INR趋于稳定,术后2周时华法令用量为(2.56±0.57)mg,INR达2.11±0.67。随访1～2年,平均18月,总随访62个患者年,出院后平均口服华法令量为(2.66±0.72)mg,INR达1.98±0.54(1.44～2.52)。出血并发症12例。出血性事件发生率为19.35%患者年,其中轻度出血8例(7例INR<2.5,1例>2.5)中度出血2例(INR>2.5),重度出血2例(INR>3.0)。10例出血发生在3个月内,2例出血发生在3～6个月内。全组无血栓、栓塞和死亡。【结论】机械瓣膜替换术的患者口服华法令抗凝治疗,建议INR的理想范围保持在1.80～2.50为适宜。
ObjectiveTo explore the best range of international normalized ratio(INR) for anticoagulation treatment after mechanical heart valve replacement. MethodForty patients undergoing heart valve replacement(CarboMedics bileaflet prosthesis) from April 2000 to April 2002 received prospective clinical research. They were treated with 3 mg warfarin 24 hours after operation every day. The posterior dosages of warfarin were adjusted according to INR. INR was tested every day in the first 14 days after operation. After discharge INR was tested for 14 times according to the project in 1-2 years. The observed items also included hemorrhage, thrombosis, embolism, death,and so on.ResultsINR would trend to stability after taking orally warfarin 3-5 days. The usage dosage of warfarin in this case was (2.56±0.57)mg 2 weeks after operation and INR achieved to 2.11±0.67,while post-discharge the dosage was (2.66±0.72)mg and INR became 1.98±0.54. All patients were followed up 1-2 years(18 months on average). Twelve patients (19.35%, suffer year) complicated bleeding. Among them 8 patients were slight bleeding (7 patients' INR were lower than 2.5, 1 patient′s INR was super than 2.5); 2 moderate patients'INR were super 2.5 and 2 heavy patients′INR were super 3. Ten patients bled in 3 months after operation and 2 patients did from 3 months to 6 months. There were no thrombosis, embolism, and death in these cases. ConclusionFor mechanical heart valve replacement patients taking orally warfarin for anticoagulant therapy, the valve of INR was recommend to range from 1.8 to 2.5.
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2004年第6期568-572,共5页
Journal of Sun Yat-Sen University:Medical Sciences
基金
美国SulzerCarbomedics公司和ITC公司横向基金资助项目(2000)
