11例心脏瓣膜置换术后妊娠期抗凝治疗的护理

目的探讨心脏瓣膜置换术后妊娠期抗凝治疗的监护,提高心脏手术后妇女的优生率.方法11例心脏瓣膜置换术后的妇女从确定妊娠开始,由口服华法令抗凝改为妊娠确诊后前3个月和分娩前2周皮下注射肝素抗凝,其余时间口服华法令抗凝;调整抗凝剂用量,使活化部分凝血酶时间（APTT）为50～55s,国际标准化比值（INR）为1.5～1.8,凝血酶泵时间（PT）保持在正常对照的1.5～2.0倍.并加强产前检查,预防心力衰竭,了解胎儿发育情况,消除焦虑心理,指导合理饮食.结果1例胎儿脑积水、死胎引产,10例孕足月,其中1例孕妇发生右腹股沟血肿,1例孕妇出现糖耐量异常,均行择期剖宫产,新生儿均健康.结论安全有效的抗凝治疗是心脏瓣膜置换术后孕妇优生的关键.

Care of 11 anti-coagulation treatment during gestation after heart valve replacement

Objective To explore nursing care of anti-coagulation treatment during gestation after hear valve replacement and improve eugenic rate after heart surgery.Methods Eleven female patients after heart valve replacement were injected with heparin in the first 3 months of pregnancy 2 weeks before delivery since affirmative diagnosis of pregnancy.For other time,they took Warfarin,the dosage adjusted: APTT=50~55 s,INR=1.5~1.8,and PT 1.5~2.0 times of normal amount.In addition,such measures were taken as enhanced antenatal care,prevention of heart failure,understanding of fetal development,alleviation of patient's anxiety and instruction of reasonable diets.Results One fetus died of hydrocephalus.Ten fetus developed for full months,except one with hematoma in the right groin and another with abnormal glucose tolerance.All the fetus were delivered normally.Conclusion Safe and effective anti-coagulation therapy is key to eugenic rate.