机械瓣置换术后华法林抗凝治疗的临床研究

目的探讨心脏人工机械瓣置换术后抗凝药物华法林治疗的给药方法、影响因素和可达到理想抗凝效果的国际标准化比值(INR)。方法从2003年7月至2006年4月,对113例因瓣膜疾病行人工瓣膜置换的患者进行了回顾性的临床研究。术后按计划采用抗凝药物华法林治疗,出院后复查随访由专人负责按照设计时间做INR值的测定。观察出血、栓塞、死亡等瓣膜相关病态事件的发生率及其临床意义。结果手术后住院期间无死亡,出院死亡4例,占3.54%,脑出血1例,占0.09%,泌尿系出血1例,占0.09%。出院随访因抗凝出现病态事件的发生率与国外文献报道相近。结论心脏机械瓣置换术后服用抗凝药物华法林,与患者的年龄、性别、体重无关,与患者当时的肝功能有关系。手术后前4天给等剂量华法林,大多患者INR呈持续上升,应根据病情及国人的生理特点给个体化药量。我们推荐INR值在1.8～2.6之间就可以达到理想的抗凝效果,且相对安全。

The clinical study of oral warfarin therapy after mechanical valve implantation

Objective To inquire into the suitable dose of warfarin for patients with mechanic valve replacement. Methods From July 2003 to April 2006,113 patients were accepted mechanical valve implantation. Warfarin therapy was given at the second day after operation. The first oral dose of warfarin was 3 mg/d for all patients. International normalized ratio (INR) was monitored according to the postoperative anticoagulation protocol during the follow-up. The value of INR was keep at 1.8 to 2.6. Anticoagulation related event included hemorrhage, Thromboembolism and death incidence. Results There was no hospital death. There were four deaths during follow-up (3.54%). One case had brine bleeding (0.09%). Urinary tract bleeding was in one case(0.09%). The incidence of anticoagulation related event was simulated to the data in the up date literature. The value of INR was continuatively increased the first four days after operation. There were not relationship between the complication related anticoagulation and the patient's age or weight excepted the hepatic function of patients. Conclusion The oral dose of warfarin was regulated with individuate to keep INR at 1.8 to 2.6,which was relative safety and provided satisfactory results of anticoagulation therapy.