摘要
目的探讨心脏机械瓣膜置换术后低强度抗凝治疗中缺血性脑卒中发生的危险因素及其防治方法。方法将2004年3月至2008年7月我科收治的机械瓣膜置换术后发生缺血性脑卒中患者23例纳入研究（缺血性脑卒中组），随机选择同期行心脏机械瓣膜置换术后患者120例作为对照（对照组），比较两组患者的性别、年龄、华法林用量、抗凝强度[国际标准化比值（INR）]及INR复查间隔时间、左心房内径、心律等指标，采用logistic回归分析缺血性脑卒中发生的危险因素。结果（1）缺血性脑卒中组患者入院后经相关治疗均顺利出院，住院期间无1例死亡，出院后随访1个月～3年，全组患者神经系统并发症均有明显恢复，无再发栓塞及抗凝治疗中的严重出血发生；（2）两组患者性别、年龄、华法林用量比较差异无统计学意义（P〉0．05）；（3）对影响因素进行非条件logistic回归分析结果，心房颤动（P=0．000）、左心房增大（P=0．002）、抗凝强度过低（P=0．012）、INR复查间隔过长（P=0．047）为心脏机械瓣膜置换术后低强度抗凝治疗中缺血性脑卒中发生的危险因素。结论（1）心脏机械瓣膜置换术后低强度抗凝治疗中缺血性脑卒中的预后相对于颅内出血较好，其发生与多个危险因素有关；（2）临床上应该尽可能减少各项危险因素对抗凝治疗的影响，以避免缺血性脑卒中的发生；（3）心脏机械瓣膜置换术后抗凝治疗中发生缺血性脑卒中的患者早期进行低强度抗凝治疗较安全、有效。
Objective To investigate the risk factors and the prevention and cure methods of ischemic stroke during low intensity anticoagulation therapy after mechanical heart valve replacement. Methods From March 2004 to July 2008, twenty-three patients with isehemie stroke after mechanical heart valve replacement had been researched （ischemic stroke group）. One hundred and twenty patients who had undergone mechanical heart valve replacement were randomly chosen in the same period as control group. Gender, age, the dose of warfarin , anticoagulation intensity（INR）, INR review interval, left atrial diameter and heart rhythm were compared between the two groups, and the risk factors of isehemic stroke were analyzed by logistic regression analysis. Results （1） Patients in ischemic stroke group all discharged from hospital after treatment, and they were followed up for 1 month- 3 years after discharged. All the patients＇ neurological complications improved obviously, and no recurrent embolism and severe hemorrhage was found. （2） There was no statistical significance between two groups in gender, age and the dose of warfarin（P〉0.05）. （3） Non-conditional logistic regression analysis on influence factors showed that atrial fibrillation （P=0. 000）, left atrial enlargement（P=0. 002）, low anticoagulation intensity（P=0. 012） and long-time INR review interval（P = 0. 047）were the risk factors of ischemic stroke during low intensity anticoagulation therapy after mechanical heart valve replacement. Conclusions （1）The prognosis of ischemic stroke during low intensity antieoagulation therapy after mechanical heart valve replacement is better than that of intracranial hemorrhage, and the occurrence of ischemic stroke is related to many risk factors. （2）The influences of risk factors should be minimized in order to avoid ischemic stroke. （3） Early low intensity anticoaguiation therapy is safe and effective for patients with ischemic stroke after heart valve replacement.
出处
《中国胸心血管外科临床杂志》
CAS
2009年第3期183-187,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
心瓣膜置换术
缺血性脑卒中
抗凝治疗
危险因素
Heart valve replacement
Ischernic stroke
Antieoagulation therapy
Risk factor
