心脏瓣膜置换术后行妇科手术抗凝方案探讨

发布时间：2018-10-14 20:30

【摘要】：目的:探讨心脏机械瓣膜置换术后行妇科手术患者抗凝治疗的方法。方法:回顾性分析我院心脏瓣膜置换术后行妇科手术30例患者的临床资料。患者入院后停用华法林,采用低分子肝素皮下注射替代治疗,术前12 h停用,术后12~24 h恢复低分子肝素治疗,同时口服华法林,根据凝血指标逐渐调整华法林至合适用量。记录患者围术期凝血指标变化、手术前后血红蛋白、术中出血量、深静脉血栓发生率等。结果:30例患者围术期通过低分子肝素替代华法林桥接治疗,凝血酶原时间及国际标准化比率均明显下降;18例刮宫手术患者手术前后血红蛋白比较差异无统计学意义,12例经腹手术患者手术前后血红蛋白比较差异有统计学意义,但无不可控制的出血发生;所有患者均未发现血栓形成和下肢深静脉血栓栓塞。结论:心脏瓣膜置换术后行妇科手术患者围术期应用低分子肝素替代华法林抗凝治疗是安全可行的,可有效控制出血和预防血栓形成。
[Abstract]:Objective: to investigate the anticoagulant therapy of gynecologic patients after mechanical valve replacement. Methods: the clinical data of 30 patients undergoing gynecological surgery after cardiac valve replacement in our hospital were retrospectively analyzed. The patients stopped warfarin after admission, received hypodermic replacement therapy with low-molecular-weight heparin (LMWH), stopped it 12 hours before operation, resumed low-molecular-weight heparin therapy at 1224 hours after operation, and took warfarin orally at the same time, and gradually adjusted warfarin to appropriate dosage according to coagulation index. The changes of coagulation indexes, hemoglobin, intraoperative blood loss and the incidence of deep venous thrombosis were recorded. Results: 30 patients were treated with low-molecular-weight heparin (LMWH) instead of warfarin during perioperative period. The prothrombin time and the international standardized rate were significantly decreased, there was no significant difference in hemoglobin before and after operation in 18 patients with curettage, but there was significant difference in hemoglobin before and after operation in 12 patients undergoing abdominal surgery. There was no uncontrolled bleeding and no thrombus formation or deep venous thromboembolism was found in all patients. Conclusion: it is safe and feasible to use low-molecular-weight heparin instead of warfarin in patients undergoing gynecological surgery after cardiac valve replacement, which can effectively control bleeding and prevent thrombosis.
【作者单位】：南京医科大学附属南京医院(南京市第一医院)妇科;
【分类号】：R654.2;R713

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