198例心脏机械瓣膜置换术患者口服华法林的临床监测及护理

目的研究心脏机械瓣膜置换术后口服华法林患者血浆凝血酶原前体蛋白(prothrombin precursor protein,PIVKA-Ⅱ)、凝血酶原时间(prothrombintime,PT)、国际标准化比率(international normalized rate,INR)的变化及其临床意义。方法 198例心脏机械瓣膜置换术后口服华法林患者为病例组,30例门诊体检人员为健康对照组,分别进行血浆PIVKA-Ⅱ、PT、INR测定。结果研究组首次服华法林后8h后,血浆PIVKA-Ⅱ浓度即显著增高,差异有统计学意义(P0.05);首次服华法林24h后,PT、INR显著增高,差异有统计学意义(P0.05)。抗凝后多数患者有不同程度的出血,其中2例出现腰大肌血肿,3例出现脑出血,1例出现脑血栓,经手术治疗、药物调整及护理后均康复。结论上述指标能较客观地反映心脏机械瓣膜置换术后口服华法林患者的病理变化过程。对患者进行心理治疗等护理可以提高治疗效果、减少并发症。

Clinical monitoring and nursing on 198 patients administered oral warfarin after cardiac valve replacement

Objective To investigate the conditions of prothrombin precursor protein （PIVKA-Ⅱ）,prothrombin time （PT） and international standardization ratio （INR） in the patients administered oral warfarin after cardiac valve replacement and to study the clinical significance.Methods 158 patients administered oral warfarin after cardiac valve replacement were taken as experimental group,and 30 healthy cases were selected as control group.PIVKA-Ⅱ,PT and INR were detected in the two groups.Results PIVKA-Ⅱ concentration increased significantly 8 h after administration of oral warfarin （P〈0.05）,while PT and INR increased significantly 24 h after administration of oral warfarin （P〈0.05）.After the treatment of anticoagulation,most patients had hemorrhage in different degree,including 2 cases of waist muscles hematoma,3 cases of cerebral hemorrhage and 1 case of cerebral thrombus.However,all of them were healing after operative treatment,adjustment of drugs and nursing.Conclusion PIVKA-Ⅱ,PT and INR can objectively reflect the pathologic process of patients administered oral warfarin after cardiac valve replacement and comprehensive nursing of patients can improve the therapeutic effect and reduce complications.