心脏机械瓣膜置换术后华法林相关脑出血的治疗分析

目的探讨心脏机械瓣膜置换术后华法林相关脑出血的治疗方法及其疗效。方法回顾性分析2017年1月至2020年1月收治的10例心脏机械瓣膜置换术后华法林相关脑出血的临床资料。结果保守治疗成功3例,急诊开颅血肿清除+去骨瓣减压术4例,侧脑室外引流术1例,病情快速进展无法手术2例。10例住院期间均未见瓣膜血栓、深静脉血栓等。3例死亡,病死率为30%。6例在2周后重启华法林治疗,其中1例出现消化道大出血及肺部感染而死亡,2例出现原发部位的脑出血再次手术治疗。7例存活病人随访6个月,GOS评分5分2例,4分2例,3分2例,2分1例。结论脑出血是心脏机械瓣膜置换术后口服华法林的严重并发症,积极改善凝血功能,并进行个体化的治疗,能有效提高病人生存率和生活质量。

Treatment of warfarin-related cerebral hemorrhage after mechanical heart valve replacement

Objective To explore the treatment and outcomes of warfarin-associated intracerebral hemorrhage (WICH) after mechanical heart valve replacement (MHVR). Methods The clinical data of 10 patients with WICH after MHVR who were admitted to our hospital from January 2017 to January 2020 were retrospectively analyzed. Results Of these 10 patients, 3 patients were treated by conservative treatment, 4 by emergency craniotomy and decompression, 1 by lateral ventricular drainage, and 2 unable to operate due to rapid disease progression. There was no valvular thrombosis and deep vein thrombosis during hospitalization. Of 6 patients who were restarted warfarin treatment 2 weeks later, 1 patient died of gastrointestinal hemorrhage and lung infection, and 2 had primary hemorrhage at the original site. Of 10 patients, 3 patients died and 7 survived. Of 7 aurvivals who were followed up for an average of 6 months, 2 patients had GOS score of 5, 2 GOS score of 4, 2 GOS score of 3, 1 GOS score of 2. Conclusion Intracerebral hemorrhage is a severe complication of warfarin treatment after MHVR. Improving coagulation function and individualized treatment can effectively improve survival rate and quality of life