心脏机械瓣膜置换术后两种不同抗凝强度的对比研究
发布时间：2019-04-19 07:43
【摘要】：目的:通过对我院心脏机械瓣膜置换术后患者抗凝强度及抗凝相关并发症进行随访研究,为我国制定安全有效的心脏机械瓣膜置换术后抗凝强度标准提供依据,为临床抗凝治疗提供参考。方法:根据严格的纳入排除标准,纳入2014年1月至2016年10月于山西医科大学第一医院心胸外科行心脏机械瓣膜置换术后使用华法林抗凝治疗的患者162例。对研究对象的术后抗凝强度及抗凝相关并发症进行随访。根据抗凝强度高低将研究对象分为A、B两组。统计分析A组与B组抗凝相关并发症的发生率是否存在差异。对未出现并发症病例的抗凝强度进行统计学分析,得出安全有效的抗凝强度范围。结果:随访患者3~34个月,共纳入162例患者,共发生出血11例(6.79%),其中脑出血1例(0.62%),消化道出血1例,鼻出血3例,牙龈出血6例;血栓栓塞共3例(1.85%),其中脑梗塞1例,右下肢动脉栓塞2例。A组共103例,其中出血2例(1.94%),血栓栓塞3例(2.91%),B组共59例,其中出血9例(15.25%),血栓栓塞0例(0.00%)。A组与B组PT值及INR值之间均存在统计学差异(P0.05)。A组比B组抗凝相关并发症的发生率低且有统计学差异(P0.05)。A组比B组出血并发症的发生率低且有统计学差异(P0.05)。A组与B组血栓栓塞(TE)并发症的发生率无统计学差异(P0.05)。二尖瓣膜置换术后华法林抗凝治疗,A组与B组抗凝相关并发症的发生率无统计学差异(P0.05),A组比B组抗凝相关出血的发生率低且有统计学差异(P0.05),而抗凝相关血栓栓塞的发生率无统计学差异(P0.05)。二尖瓣置换(MVR)与主动脉瓣置换(AVR)、二尖瓣置换(MVR)与双瓣置换(DVR)、主动脉瓣置换(AVR)与双瓣置换术(DVR)后抗凝相关并发症的发生率均无统计学差异。心脏机械瓣膜置换术后华法林抗凝治疗PT值的安全范围是19.32~26.6s,INR值的安全范围是1.55~2.2。结论:心脏机械瓣膜置换术后较低强度抗凝治疗能降低出血发生率,且不增加血栓栓塞发生率,故较低强度抗凝是可行的。本研究得出心脏机械瓣膜置换术后华法林抗凝治疗的PT安全范围是19.32~26.6s,INR安全范围是1.55~2.2。
[Abstract]:Objective: through the follow-up study on anticoagulation intensity and related complications of patients after mechanical valve replacement in our hospital, to provide the basis for establishing a safe and effective standard of anticoagulation strength after mechanical valve replacement in our country. It provides reference for clinical anticoagulation therapy. Methods: from January 2014 to October 2016, 162 patients who were treated with warfarin anticoagulation after mechanical heart valve replacement were included according to the strict inclusion exclusion criteria in the Department of Cardiothoracic surgery of the first Hospital of Shanxi Medical University from January 2014 to October 2016. The postoperative anticoagulation intensity and anticoagulation related complications were followed up. According to the level of anti-coagulation strength, the subjects were divided into two groups: group A and group B. The incidence of anticoagulation-related complications between group A and group B was statistically analyzed. A safe and effective range of anticoagulation strength was obtained by statistical analysis of anticoagulation intensity in patients without complications. Results: a total of 162 patients were included in the follow-up for 34 months. There were 11 cases (6.79%) of hemorrhage, including 1 case of cerebral hemorrhage (0.62%), 1 case of gastrointestinal bleeding, 3 cases of nosebleed and 6 cases of gingival bleeding. There were 3 cases (1.85%) of thromboembolism, including 1 case of cerebral infarction and 2 cases of arterial embolism of the right lower extremities. Group A consisted of 103 cases, of which 2 cases (1.94%) were bleeding, 3 cases (2.91%) were thromboembolism, 59 cases were in group A (2.91%), B). Of these, 9 (15.25%) had bleeding. There was a significant difference in PT and INR between 0 cases of thromboembolism (0.001%). A group and B group) (P 0.05). A group was lower than B group in the incidence of anticoagulation-related complications (P0.05). A). The incidence of bleeding complications in group B was lower than that in group B (P 0.05). There was no significant difference in incidence of (TE) complications between group). A and group B (P0.05). There was no significant difference in the incidence of anticoagulation-related complications between group A and group B after valvular replacement with warfarin (P0.05). The incidence of anticoagulation-related bleeding in group), A was significantly lower than that in group B (P0.05), and there was no significant difference between group A and group B (P0.05). There was no significant difference in the incidence of anticoagulation-associated thromboembolism (P0.05). There was no significant difference between mitral valve replacement (MVR) and aortic valve replacement (AVR), mitral valve replacement (MVR) and double valve replacement (DVR), aortic valve replacement (AVR) and anticoagulation related complications after double valve replacement after (DVR). The safety range of warfarin anticoagulant therapy after mechanical heart valve replacement is 19.32? 26.6s, and the safe range of INR is 1.55? 2.2.The safety range of warfarin anticoagulation is 19.32? 26.6s and 1.55? 2.2. Conclusion: low intensity anticoagulation therapy can reduce the incidence of bleeding and not increase the incidence of thromboembolism after mechanical valve replacement, so it is feasible to use low intensity anticoagulation therapy. In this study, the safety range of warfarin anticoagulant therapy after mechanical heart valve replacement was 19.32? 26.6s, and the safe range of PT was 1.55? 2.2.The safety range of warfarin was 19.32? 26.6s and 1.55? 2.2.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2
本文编号：2460755
[Abstract]:Objective: through the follow-up study on anticoagulation intensity and related complications of patients after mechanical valve replacement in our hospital, to provide the basis for establishing a safe and effective standard of anticoagulation strength after mechanical valve replacement in our country. It provides reference for clinical anticoagulation therapy. Methods: from January 2014 to October 2016, 162 patients who were treated with warfarin anticoagulation after mechanical heart valve replacement were included according to the strict inclusion exclusion criteria in the Department of Cardiothoracic surgery of the first Hospital of Shanxi Medical University from January 2014 to October 2016. The postoperative anticoagulation intensity and anticoagulation related complications were followed up. According to the level of anti-coagulation strength, the subjects were divided into two groups: group A and group B. The incidence of anticoagulation-related complications between group A and group B was statistically analyzed. A safe and effective range of anticoagulation strength was obtained by statistical analysis of anticoagulation intensity in patients without complications. Results: a total of 162 patients were included in the follow-up for 34 months. There were 11 cases (6.79%) of hemorrhage, including 1 case of cerebral hemorrhage (0.62%), 1 case of gastrointestinal bleeding, 3 cases of nosebleed and 6 cases of gingival bleeding. There were 3 cases (1.85%) of thromboembolism, including 1 case of cerebral infarction and 2 cases of arterial embolism of the right lower extremities. Group A consisted of 103 cases, of which 2 cases (1.94%) were bleeding, 3 cases (2.91%) were thromboembolism, 59 cases were in group A (2.91%), B). Of these, 9 (15.25%) had bleeding. There was a significant difference in PT and INR between 0 cases of thromboembolism (0.001%). A group and B group) (P 0.05). A group was lower than B group in the incidence of anticoagulation-related complications (P0.05). A). The incidence of bleeding complications in group B was lower than that in group B (P 0.05). There was no significant difference in incidence of (TE) complications between group). A and group B (P0.05). There was no significant difference in the incidence of anticoagulation-related complications between group A and group B after valvular replacement with warfarin (P0.05). The incidence of anticoagulation-related bleeding in group), A was significantly lower than that in group B (P0.05), and there was no significant difference between group A and group B (P0.05). There was no significant difference in the incidence of anticoagulation-associated thromboembolism (P0.05). There was no significant difference between mitral valve replacement (MVR) and aortic valve replacement (AVR), mitral valve replacement (MVR) and double valve replacement (DVR), aortic valve replacement (AVR) and anticoagulation related complications after double valve replacement after (DVR). The safety range of warfarin anticoagulant therapy after mechanical heart valve replacement is 19.32? 26.6s, and the safe range of INR is 1.55? 2.2.The safety range of warfarin anticoagulation is 19.32? 26.6s and 1.55? 2.2. Conclusion: low intensity anticoagulation therapy can reduce the incidence of bleeding and not increase the incidence of thromboembolism after mechanical valve replacement, so it is feasible to use low intensity anticoagulation therapy. In this study, the safety range of warfarin anticoagulant therapy after mechanical heart valve replacement was 19.32? 26.6s, and the safe range of PT was 1.55? 2.2.The safety range of warfarin was 19.32? 26.6s and 1.55? 2.2.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2
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