内蒙古地区人工机械心脏瓣膜置换术后低强度抗凝临床分析

发布时间：2018-06-20 06:22

本文选题：人工机械瓣膜置换术 + 低强度抗凝　；参考：《内蒙古医科大学》2017年硕士论文

【摘要】：目的探讨内蒙古地区心脏机械瓣膜置换术后低强度抗凝的合理化应用。方法收集我院2012年1月-2016年12月共301例人工机械心脏瓣膜置换术后应用华法林抗凝治疗患者的临床资料,通过门诊复查或电话随访,根据国际标准化比值(International Normalized Ratio,INR)指导患者口服华法林的用量达到INR目标值1.8-2.5(AVR:1.8-2.2,MVR、DVR:1.8-2.5),建立心脏机械瓣膜术后抗凝INR数据库,记录抗凝相关并发症(出血、血栓栓塞等)。按照瓣膜置换位置的不同将患者分为AVR组、MVR组、DVR组,每组中根据抗凝达标情况再分为A亚组:抗凝不达标组(INR1.8),B亚组:抗凝达标组(INR:1.8-2.5其中AVR:1.8-2.2,MVR、DVR:1.8-2.5)和C亚组:抗凝超标组(AVR:INR2.2,MVR、DVR:INR2.5)。因C亚组病例数较少,不予比较。对比A、B亚组出血或血栓栓塞发生情况,进而探讨适合内蒙地区心脏机械瓣膜置换术后低强度抗凝的水平。结果我院实际抗凝强度为AVR组INR:1.2-2.2;MVR组INR:1.4-2.3;DVR组INR:1.3-2.2。术后抗凝过程中出现出血20例,发病率为2.81%病人年,血栓栓塞14例,发病率为1.96%病人年。总样本INR平均值为(1.81±0.26),其中A亚组139(47.1%)例,出血6(4.3%)例、血栓栓塞5(3.6%)例;B亚组:156(52.9%)例,出血14(9.0%)例、血栓栓塞9(5.8%)例。总体样本A亚组与B亚组出血及血栓栓塞发生率无统计学意义(P0.05)。AVR组:INR平均值(1.69±0.27),其中A亚组54(68.4%)例,出血1(1.9%)例、血栓栓塞3(5.6%)例;B亚组:25(31.6%)例,出血3(12.0%)例、血栓栓塞1(4.0%)例。AVR组A亚组B亚组出血及血栓栓塞发生率无统计学意义(P0.05)。MVR组:INR平均值(1.88±0.24),其中A亚组45(34.1%)例,出血4(8.9%)例、血栓栓塞1(2.2%)例;B亚组87(65.9%)例,出血9(10.3%)例、血栓栓塞6(6.9%)例。MVR组A亚组与B亚组出血及血栓栓塞发生的概率无统计学意义(P0.05)。DVR组:INR平均值(1.88±0.24),其中A亚组40(47.6%)例,出血1(2.5%)例、血栓栓塞1(2.5%)例;B亚组:44(52.4%)例,出血2(4.5%)例、血栓栓塞2(4.5%)例。DVR组A亚组与B亚组出血及血栓栓塞发生率差异无统计学意义(P0.05)。结论我院低抗凝强度AVR:1.2-1.8、MVR:1.4-1.8、DVR:1.3-1.8与INR:1.8-2.5(AVR:1.8-2.2,MVR、DVR:1.8-2.5)比较抗凝效果无差异,也是适合本地区心脏机械瓣膜置换术后患者的。
[Abstract]:Objective to explore the rational application of low-intensity anticoagulation after mechanical heart valve replacement in Inner Mongolia. Methods the clinical data of 301 patients treated with warfarin anticoagulant after artificial mechanical heart valve replacement were collected from January 2012 to December 2016 in our hospital. According to the international standardized ratio of International Normalized Ratioin (INR), the target value of oral warfarin was 1.8-2.5? AVR: 1.8-2.2? MVRRV DVR: 1.8-2.5?. The database of anticoagulant INR after cardiac mechanical valve operation was established, and the anticoagulation-related complications (hemorrhage, thromboembolism, etc.) were recorded. According to the position of valve replacement, patients were divided into AVR group (MVR group) and DVR group. Each group was divided into subgroup A according to the anticoagulant standard: subgroup A: anticoagulant subgroup 1.8-2.5 (AVR: 1.8-2.2MVRDVR: 1.8-2.5) and subgroup C: AVR: INR2.2 MVRDVR2.5). The number of cases in subgroup C was less than that in subgroup C. To compare the incidence of hemorrhage or thromboembolism in Aneb subgroup and to explore the low intensity anticoagulant level after mechanical heart valve replacement in Inner Mongolia. Results the actual anticoagulant strength of our hospital was as follows: AVR group INR: 1.2-2.2 and MVR group INR: 1.4-2.3 and DVR group INR: 1.3-2.2. There were 20 cases of bleeding in the course of postoperative anticoagulant, the incidence rate was 2.81% patient year, 14 cases were thromboembolism, the incidence rate was 1.96% patient year. The average INR of the total sample was 1.81 卤0.26, including 139U 47.1 in subgroup A, 64.3 in bleeding, 53.6 in thromboembolism, 52.6 in subgroup B), 140.0) in hemorrhage and 95.8 in thromboembolism. There was no significant difference in the incidence of hemorrhage and thromboembolism between subgroup A and subgroup B (P 0.05) .AVR group (1.69 卤0.27), including 548.4 cases in subgroup A, 1.99 cases in hemorrhage, 35.6 cases in subgroup B), 312.0% in subgroup B, and 312.0% in subgroup B, respectively. There was no significant difference in the incidence of hemorrhage and thromboembolism in subgroup A and B of AVR group. There was no significant difference in the incidence of hemorrhage and thromboembolism in subgroup A and in group A. MVR group was 1.88 卤0.24, including 454.41 cases in group A, 48.9 cases in group A, 8765.9% in subgroup B), 910.3 cases in group B). There was no significant difference in the probability of hemorrhage and thromboembolism between subgroup A and subgroup B in MVR group. There was no significant difference in the probability of hemorrhage and thromboembolism in group A and B. There were 1.88 卤0.24 in group A, 4047.6 in subgroup A, 12.5 in hemorrhage, 12.5 in subgroup B), 4452.4 in subgroup B), 24.5 in group A, 24.5 in subgroup B). There was no significant difference in the incidence of hemorrhage and thromboembolism between subgroup A and subgroup B in DVR group (P 0.05). Conclusion the anticoagulant effect of AVR: 1.2-1.8 / MVR1.4-1.8 / DVR: 1.3-1.8 and AVR: 1.8-2.5 / AVR: 1.8-2.2 / V / V / 1.8-2.5) has no difference in anticoagulant effect, and is suitable for patients with mechanical heart valve replacement in our area.
【学位授予单位】：内蒙古医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2

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