摘要
目的 探讨心脏机械瓣膜置换术后抗凝治疗中 ,颅内出血的危险因素及其防治措施。方法 随访 14例心脏机械瓣膜置换术后抗凝治疗颅内出血病人 ,分析其发生的危险因素。结果 (1)出血组14例病人中 9例行开颅血肿清除 ,1例行颅骨钻孔引流术 ,术后生存 5例 ;3例未手术者 ,死亡 ;1例经保守治疗 ,痊愈。 (2 )出血组国际标准比值 (INR) (2 4 8± 0 5 1)明显高于对照组 (1 4 4± 0 4 2 ) (P <0 0 5 )。 (3)出血组合并使用抗血小板药的人数比例 (4 8% )明显大于对照组 (13% ) (P <0 0 5 )。 (4 ) 6 4 % (9/ 14例 )的出血病人发病时间在术后 3个月内。结论 心脏机械瓣膜置换术后抗凝治疗中颅内出血的危险因素有 :抗凝强度过大 ;合并使用抗血小板药物 ;抗凝治疗早期 (前 3月 )。并探讨抗凝治疗中颅内出血的诊治方法。
Objective: To evaluate the risk factors and treatment of intracranial hemorrhage during anticoaagulation therapy following mechanical heart valve replacement. Methods: Fourteen patients with intracranial hemorrhage during anticoagulation therapy after replaced mechanical heart valve were followed up. Results: (1) Nine cases of 14 intracranial hemorrhage patients were performed craniotomy with evacuation of hematoma, and one case sphenotresia drainage, 5 patients survived after operation; one case cured by conservative treatment; and 8 cases died. (2) The INR value of hemorrhage group (2 48±0 51) was higher than that of control group (1 44±0 42) (P<0 05). (3) The rate of asprine usage in hemorrhge group higher than that of control group (P<0 05). (4) Most of the patients (64%) suffered the hemorrhage in first 3 months after valve operation. Conclusions: There were three risk factors of intracranial hemorrhge during anticoagulation therapy following mechanical heart valve replacement. High acticoagulation therapy intensity. Combining use of antiplatelet drug (Asprine). Length of anticoagulation therapy (<3 months). The diagnosis and treatment of this complication were also discussed.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2003年第4期206-208,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
