风湿性心脏病机械瓣膜置换术后华法林抗凝治疗的健康指导

目的:心脏瓣膜机械瓣置换术后,因为人造瓣膜作为异物置入心脏,易形成血栓引起栓塞,需要掌握适当的华法林抗凝治疗是巩固术后疗效与病人安全的保证.我科通过对<例机械瓣膜置换术后抗凝治疗的健康指导,发现合适的抗凝治疗,对机械瓣膜置换术后避免并发症的发生有重要的意义.     

心脏瓣膜置换术后抗凝治疗的护理

抗凝治疗是心脏瓣膜置换术后保证人工瓣膜功能正常、防止血栓形成的主要方法。我院1995年10月至1999年11月,对43例心脏瓣膜病病人在体外循环下实施人工机械瓣膜置换术,术后常规抗凝治疗,效果满意,现将抗凝治疗的护理报告如下。     

延续性护理对心脏瓣膜置换术后患者抗凝治疗依从性的影响

目的分析延续性护理对心脏瓣膜置换术后患者抗凝治疗依从性的影响。方法选取98例在郑州大学第二附属医院接受心脏瓣膜置换术的患者。将2017-01-2018-02间入院的48例患者作为常规组,术后实施常规护理。将2018-03-2019-03间入院的50例患者作为延续组,在常规护理的基础上积极开展延续性护理干预。分析2组患者随访期间对抗凝知识的掌握程度、抗凝治疗依从性和并发症的发生率。结果 2组患者术后均随访6个月。出院后3及6个月时延续组患者对抗凝知识的掌握程度和抗凝治疗依从性均优于常规组,随访期间并发症发生率低于常规组,差异均有统计学意义(P<0.05)。结论对心脏瓣膜置换术后患者科学、全面做好延续性护理,能够提高其对抗凝知识的掌握程度和抗凝治疗依从性,降低抗凝不当引起的并发症发生风险,促进早期康复。     

心脏机械瓣膜置换术后抗凝监测的方法学研究及临床意义

目的探讨定量检测血浆中凝血酶原及华法林浓度等指标,在心脏机械瓣膜置换术后抗凝监测中的意义.方法动态监测65例心脏机械瓣膜置换术后抗凝病人血浆凝血酶原、华法林血药浓度、凝血因子VII活性、国际标准比值(INR)、口服华法林剂量及临床并发症情况.比较出血组与对照组间各种抗凝监测指标的差异.结果(1)出血组血浆凝血酶原浓度(81.45±41.27)?mg/L明显低于对照组(128.55±31.58)?mg/L(P＜0.01),华法林血药浓度(546.93±148.18)?ng/ml则明显高于对照组(399.47±107.28)?ng/ml(P＜0.05);两组间INR值、VII因子活性及口服华法林剂量差异均不明显(P＞0.05);(2)动态观察华法林血药浓度及血浆凝血酶原值稳定性较INR值好;(3)血浆凝血酶原浓度与华法林血药浓度(r=-0.849;P＜0.01)以及INR值与VII因子活性(r=-0.781;P＜0.01)明显相关.结论定量测定血浆凝血酶原浓度及华法林血药浓度有助于准确进行心脏机械瓣膜置换术后的抗凝监测.     

机械瓣膜置换术后华法令抗凝治疗的护理

目的通过对机械瓣膜置换术的术后患者口服抗凝剂华法令后抗凝指导,观察术后康复疗效。方法对笔者所在医院2007～2011年收治的98例心脏机械瓣膜置换术的患者进行口服抗凝剂华法令的健康宣教,主要包括具体药物用法、用药期间的饮食、对出院患者相应的愈后康复指导等。结果 98例患者均取得良好的治疗效果,患者住院期间无并发症发生。出院后,1例患者发生脑出血,经住院治疗后好转出院。结论机械瓣膜置换术后华法令抗凝治疗的护理,可有效减少术后并发症的发生。     

抗凝治疗量表用于心脏机械瓣膜置换术后患者的信效度检验

目的 引进和翻译抗凝治疗量表,将中文版量表应用于心脏机械瓣膜置换术后出院患者,并对其进行信效度检验.方法 将英文版抗凝治疗量表进行汉化,形成中文版.应用中文版量表对心脏机械瓣膜置换术后患者进行调查,计算分析量表信度和效度.结果 量表提取3个公因子,共16个条目,累积方差贡献率为56.375％;重测信度为0.929,Cr...     

心脏机械瓣膜置换术后妊娠妇女的抗凝治疗

1979年至 1999年期间 ,我们共行心脏瓣膜置换术 10 37例 ,其中 ,有 14例女病人行机械瓣膜置换术后妊娠 15次。现将此 14例病人的抗凝治疗方法报道如下。临床资料　 14例女病人年龄 2 3～ 36岁。行二尖瓣置换术 (ＭＶＲ) 11例 ,主动脉瓣置换术 (ＡＶＲ) 3例。植入瓣膜分别为Ｃａｒｂｏｍｅｄｉｃｓ瓣 5例 ,国产ＧＫ瓣 4例 ,ＣＬ瓣、Ｍｅｄｔｒｏｎｉｃ瓣各2例 ,Ｓｔ.Ｊｕｄｅ瓣 1例。术前病人心功能 (ＮＹＨＡ)ＩＶ级 4例 ,ＩＩＩ级 10例 ;术后心功能Ｉ级 8例 ,ＩＩ级 6例。全组病人均采用口服抗凝药治疗。进口华法林 (ｏｒｉｏｎｐｈａｒｍ…     

心脏瓣膜置换术后服用终身抗凝药物的观察体会

血栓栓塞是人造心脏瓣膜置换术后的严重并发症,不论应用机械瓣或生物瓣,术后均须抗凝治疗.采用适当的抗凝治疗方法,是巩固瓣膜置换术的疗效,维系病人安全和健康的有力保障.护理人员通过对病人服药的宣教,病情的观察,以及病人自己的信息反馈,及时的将病情变化报告医生,给予相应积极的处理,为终身服药提供客观依据.现将08年3月-10年3月,施行机械换瓣手术172例,术后服用终身抗凝药物华法林的观察体会回报如下.     

应用国际标准比值监测心脏机械瓣膜替换术后抗凝治疗

心脏机械瓣膜替换术后抗凝治疗与术后远期生存质量及并发症密切相关。准确的抗凝监测是正确抗凝治疗的保证。我们按照ＷＨＯ推荐的方法标定２种国产兔脑粉凝血激酶的国际敏感指数（ｉｎｔｅｒｎａｔｉｏｎａｌｓｅｎｓｉｔｉｖｉｔｙｉｎｄｅｘ，ＩＳＩ），探讨国际标准...     

心脏机械瓣膜置换术后抗凝治疗中的颅内出血

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。     

微信打卡考勤随访在心脏机械瓣膜置换术后患者中的应用

目的探讨微信打卡考勤随访对心脏机械瓣膜置换术后患者抗凝治疗依从性的影响。方法将108例心脏机械瓣膜置换术后出院患者随机均分成两组。对照组(54例)在出院时行常规微信教育;观察组(54例)在常规微信教育基础上,参照职场打卡模式由患者行抗凝药物服用回复,护士行跟踪服务。结果观察组抗凝治疗依从性显著优于对照组(均P0.01),相关并发症发生率相对低于对照组,但差异无统计学意义(均P0.05)。结论微信打卡考勤随访可以提高心脏机械瓣膜置换术后患者抗凝治疗依从性,减少并发症。     

健康教育路径对机械心脏瓣膜置换患者出院准备水平的影响

目的探讨健康教育路径对机械心脏瓣膜置换患者出院准备水平的影响。方法将90例接受机械心脏瓣膜置换患者按照入院顺序分为对照组与观察组各45例。对照组接受常规健康教育;观察组建立健康教育路径,制作成健康教育卡进行健康教育。出院当天评价两组患者出院教育质量和出院准备水平。结果观察组出院教育质量及出院准备水平显著高于对照组(均P0.01)。结论健康教育路径能有效提高患者的出院教育质量和出院准备水平。     

心脏机械瓣置换后不同强度抗凝对病人凝血激活的影响

目的　探讨不同强度抗凝时 ,心脏机械瓣置换术后病人的凝血激活状态。方法　将 16 2例心脏机械瓣置换术后病人 ,根据抗凝强度 (INR)分成 4组 :A组 (<1 5 ) 2 5例 ;B组 (1 5～ <2 0 ) 4 4例 ;C组 (2 0～ <3 0 ) 6 1例 ;D组 (3 0～ <4 5 ) 32例。 2 0例正常成人为对照组。采用酶联免疫吸附法 (ELISA)测定各组血浆凝血酶原片段 1+2 (F1 + 2 )、D 二聚体浓度。结果　A、B、C、D和对照组F1 + 2 浓度分别为(2 4 8± 1 32 )、(1 2 3± 0 6 5 )、(0 81± 0 4 5 )、(0 73± 0 39)、(1 11± 0 35 )nmol L ;D 二聚体浓度分别为(0 4 5± 0 2 4 )、(0 30± 0 17)、(0 2 4± 0 10 )、(0 2 5± 0 11)、(0 2 1± 0 0 9)mg L。A组F1 + 2 和D -二聚体浓度均显著高于对照组 (P <0 0 1) ;B组F1 + 2 浓度与对照组无差异 (P >0 0 5 ) ,D 二聚体浓度显著高于对照组 (P <0 0 5 ) ;C、D组F1 + 2 浓度均显著低于对照组 (P <0 0 5 ) ,但C、D两组间差异无显著性 (P >0 0 5 ) ;C、D组D 二聚体浓度与对照组之间均差异无显著性 (P >0 0 5 )。结论　在INR 2 0～ 3 0的抗凝强度下 ,心脏机械瓣置换术后病人凝血激活受到明显抑制     

心脏机械瓣膜置换术后抗凝治疗

抗凝治疗中的出血与栓塞是心脏机械瓣膜置换术后最重要的远期并发症.我国心脏机械瓣膜置换术后患者抗凝治疗的主要矛盾是出血,应降低抗凝强度,减少出血并发症.近年来,心脏机械瓣膜置换术后抗凝治疗的主要进展是采用国际标准比值(INR)监测抗凝和低强度抗凝治疗.目前国内采用的INR为1.5～2.0,凝血酶原时间比值(PTR)为1.3～1.5的抗凝治疗强度,有利于降低抗凝患者的出血病死率以及妊娠妇女、新生儿的并发症,并能改善患者的生活质量.     

Self-management of oral anticoagulant therapy for mechanical heart valve patients

OBJECTIVE: Self-management of oral anticoagulant therapy (OAT) has shown good results on a short-term basis. We hypothesize that self-management of OAT provides a better quality of treatment than conventional management also on a long-term basis. The aim of this study was to assess the quality of self-management of OAT in patients with mechanical heart valve prostheses on a 4-year perspective in a prospective, non-randomized study. DESIGN: Twenty-four patients with mechanical heart valves and on self-managed OAT were followed for up to 4 years. A matched, retrospectively selected group of conventionally managed heart valve patients (control group) was used as reference. RESULTS: The median observation time was 1175 days (range: 174-1428 days). The self-managed patients were within therapeutic INR target range for a mean of 78.0% (range: 36.1%-93.9%) of the time compared with 61.0% (range 37.4%-2.9%) for the control group. CONCLUSION: Self-management of OAT is a feasible and safe concept for selected patients with mechanical heart valve prostheses also on a long-term basis. It provides at least as good and most likely better quality of anticoagulant therapy than conventional management assessed by time within the therapeutic International Normalized Ratio (INR) target range.     

Thromboembolic and bleeding complications in patients treated with oral anticoagulant therapy after mechanical heart valve prostheses implantation

Thromboembolic and bleeding events are major cause of morbidity and mortality in patients with mechanical heart valves. Ninety-three patients had been received anticoagulant (warfarin with bucolome 300 mg) for mechanical prosthetic valves, and the regulation of anticoagulation was performed within a prothrombin time international normalized ratio (PT-INR) about 2.0 of normal. The mean duration of follow-up was 64.1 months, and the total duration of follow-up was 496.8 patient-years (py). The valve related complications occurred in 10 cases (2.0 per 100 py). Anticoagulant related hemorrhagic events occurred in 7 cases, and valve thrombosis in 3 cases. All three cases of valve thrombosis were in cases with Bj?rk-Shiley valve at the mitral position. An artificial valve in mitral position increased the valve related risk compared with the aortic position (3.1%/py vs 0.0%/py). Bileaflet valve showed a lower incidence of thromboembolism than tilting disc valve (2.3%/py vs 0.0%/py). The risk of valve related complication varied with the type and the position of the prosthesis, it is desirable that the intensity of anticoagulation would be changed according to the prosthetic valve type and its position. These results suggest that the intensity of anticoagulation is optimal when the PT-INR is 1.8-2.0 for patients with bileaflet valve in the mitral position, and is 1.6-1.8 in the aortic position. Tilting disc valve needs more intensity of anticoagulation, and needs additional antiplatelet agent in the mitral position.     

心脏机械瓣膜替换术后低强度抗凝治疗

目的　探讨适合我国人群心脏机械瓣膜替换术后抗凝治疗的强度。　方法　随访 480例心脏机械瓣膜替换术后患者抗凝治疗的抗凝强度及其并发症等情况 ,并对其结果进行统计学分析。结果　本组患者 42 8例获随访 ,总随访率 89 17% ,共 2 110 0 4病人·年 (Pty)。患者服用进口华法令平均 ( 2 81± 0 95 )mg/d ,国产华法令 ( 2 38± 0 4 6 )mg/d ,2 116份标本凝血酶原时间比值 (PTR)平均 1 4 3± 0 2 6 ,1195份标本国际标准比值 (INR) 1 6 3± 0 4 9。一般性出血 78例次 ,严重出血 19例次 (其中 8例颅内出血死亡 )。总出血率 4 6 0 %Pty ,出血病死率 0 38%Pty ,出血组PTR及INR均显著高于非出血组 (t=1 816 ,P <0 0 5 ;t=2 4 0 7,P <0 0 1)。栓塞 14例 (其中 1例脑栓塞死亡 ) ,栓塞率 0 6 6 %Pty,栓塞病死率 0 0 5 %Pty。 14例患者妊娠 15例次 ,无新生儿畸形发生。　结论　 ( 1)我国心脏机械瓣膜替换术后患者抗凝治疗的主要矛盾是出血 ,应降低抗凝强度以减少出血并发症 ;( 2 )本组采用PTR为1 3～ 1 5 ,INR为 1 5～ 2 0的标准对于预防出血及栓塞较理想 ;( 3)低强度抗凝有利于降低患者出血病死率 ,及妊娠妇女、新生儿的并发症 ,并能改善患者的生活质量。     

Hemolysis after mitral valve replacement with mechanical valve prostheses

OBJECTIVE: We evaluated effects of type, size, and orientation of mechanical mitral valve prostheses on hemolysis. METHODS: Subjects were 84 patients who had undergone mitral valve replacement. Lactate dehydrogenase was mainly used as a marker of hemolysis and was measured before surgery, 1 month after surgery, and in the late postoperative period. RESULTS: Valves used included 16 Medtronic-Hall, 32 St. Jude Medical, and 36 CarboMedics valves. Medtronic-Hall valves caused less hemolysis than St. Jude Medical or CarboMedics valves in the late postoperative period. This resulted because hemolysis due to Medtronic-Hall valves was more severe 1 month after surgery than in the late postoperative period and because hemolysis due to St. Jude Medical or CarboMedics valves was more severe in the late postoperative period than 1 month after surgery. One reason for this finding is that cardiac output was greater in the late postoperative period than 1 month after surgery, making regurgitation through the pivots of bileaflet valves more severe. The orifice area and the orientation of prostheses did not affect hemolysis. CONCLUSION: St. Jude Medical or CarboMedics valves caused more severe hemolysis than Medtronic-Hall valves in the late postoperative period.     

Long-term clinical results after aortic valve replacement with mechanical heart valves and mitral valve replacement with porcine valves]

Long-term clinical results of aortic valve replacement (AVR) with mechanical heart valves and mitral valve replacement (MVR) with porcine valves were analysed. Sixty-three patients received isolated AVR and 48 received isolated MVR. Sixty-eight patients with MVR including double or triple valve replacement were also added in order to evaluate the primary tissue failure (PTF). The patients with operative deaths were excluded. Survival rate at 11 years in AVR was 68 +/- 10% and 67 +/- 15% in MVR without statistical difference. At 11 years, 76 +/- 8% of the patients in AVR were free from valve-related complications in contrast with the poor result of 34 +/- 31% in MVR (p less than 0.01). Main cause of this poor result in MVR was PTF as indicated in following event free rates; 83 +/- 9% at 7 years, 61 +/- 25% at 10 years and 49 +/- 31% at 13 years. There was no statistical difference between patients of above 50 years and below 49 years in PTF. Valve-related death event free was 93 +/- 5% in AVR and 86 +/- 11% in MVR at 11 years (not significant), however, there was statistical difference in re-operation event free rate as 94 +/- 5% in AVR and 76 +/- 11% in MVR at 11 years (p less than 0.001). These results suggest that the use of porcine valves in mitral position is confined to the selected patients.