口服华法令致脑出血患者27例的临床治疗

目的 探讨联合使用凝血酶元复合物(PCC)和维生素K(VK)对口服华法令并发脑出血患者的治疗效果.方法 首都医科大学附属北京安贞医院神经外科自2005年1月至2010年5月共收冶口服华法令抗凝而致脑出血患者27例,其中17例患者单独使用VK治疗,10例患者联合使用人PCC+VK治疗.分析患者的临床资料并比较患者抗凝指标国际标准化比值(INR)的恢复时间及预后情况.结果 PCC+VK治疗组患者纠正抗凝状态的时间为(2.8±1.4)h,明显短于VK治疗组患者[(7.8±4.1)h],且GOS评分(3.6±1.3)高于VK治疗组(2.2±1.4),差异有统计学意义(P＜0.05);秩和检验显示PCC+VK治疗组患者预后好于VK治疗组.结论 与单纯应用VK相比,联合应用PCC和VK可以更快的逆转华法令的抗凝作用,为改善患者预后创造条件.

Clinical treatment of intracranial hemorrhage due to oral warfarin therapy in 27 patients

Objective To observe the therapeutic effect of prothrombin complex concentrate (PCC) combined with vitamin K (VK) on cerebral hemorrhage related to use of oral anticoagulant (warfarin). Methods Retrospective analysis was performed on the clinical data of 27 patients with cerebral hemorrhage related to use of oral anticoagulant (warfarin), admitted to our hospital from January 2005 to May 2010. In these patients, 17 adopted VK alone, and 10 adopted PCC+VK; we compared the time for international normalized ratio (INR) of anticoagulation markers returned to normal value and the prognosis between the 2 groups. Results The average times for INR of anticoagulation markers returned to normal value in patients treated with PCC+VK were (2.8± 1.4) h, which was obviously shorter than those in ones treated with VK ([7.8±4.1] h,P＜0.05); Glasgow outcome scale scores in the PCC+VK treatment group were significantly higher than those in the VK treatment group (P＜0.05). The prognosis in the PCC+VK treatment group was better than that in the VK treatment group. Conclusion PCC combined with VK treatment seems to be more effective in rapidly correcting increased INR levels than VK treatment alone, indicating that use of PCC combined with VK may improve the prognosis of patients with intracranial hemorrhage due to oral warfarin therapy.