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许建屏, 石应康, 董 力等.中国人心脏瓣膜置换术后低强度抗凝治疗3 000例随访1年报告.四川大学学报(医学版),2016,47(1):90-92
中国人心脏瓣膜置换术后低强度抗凝治疗3 000例随访1年报告
Low Intensity Anticoagulation Therapy for Chinese Population with Heart Valve Replacement——3 000 Cases Follow-up
  
中文关键词:  心脏瓣膜置换术 抗凝治疗 随访
英文关键词:Heart valve replacement Anticoagulation therapy Follow-up
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中文摘要:
      目的 研究中国人心脏瓣膜置换术后早期低强度抗凝的疗效。方法 对2011年1月至2012年3月间,北京阜外医院成人心脏中心和四川大学华西医院心外科有完整住院资料的3 000例瓣膜置换术后患者随访1年,分析抗凝治疗强度、方法及并发症等指标。结果 共2 657例获随访,随访率88.57% ,随访总量1 726.1患者/年(Pty)。 华法林剂量0.625~12.0(2.68±6.45) mg/d;阜外医院国际标准比值(INR)实测均值为2.01±1.10, 华西医院1.86±0.69,两院间实际抗凝强度(INR均值1.8~2.0) 相似,差异无统计学意义(P=0.28)。抗凝总并发症发生及死亡率分别为5.79% Pty与0.12% Pty;其中出血发生及死亡率分别为3.59% Pty与0.12% Pty;严重性出血发生及死亡率分别为0.29% Pty与0.12% Pty;栓塞发生及死亡率分别为2.03% Pty与0.00% Pty,血栓形成发生及死亡率分别为0.29% Pty与0.00% Pty。 结论 中国人心脏瓣膜置换术后采用低强度抗凝治疗(INR 1.5~2.5),取得了栓塞与血栓并发症发生率无明显增加,出血并发症发生及死亡率明显降低的疗效。 国人抗凝治疗强度并无明显地域差别。
英文摘要:
      Objective To investigate the effect of low-intensity anticoagulation therapy for Chinese population with heart valve replacement. Methods From January 2011 to March 2012, 3 000 patients with heart valve replacement in Fuwai Hospital and West China Hospital were followed-up for 1 year, the method and intensity of postoperative anticoagulation, as well as the complications were studied and analyzed. Results The rate of follow-up was 88.57%, and the cumulative follow-up was 1 726.1 patient-years (Pty). The mean oral warfarin dosage was (2.68±6.45) mg/d, and the mean INR values of the patients treated in Fuwai Hospital and West China Hospital were 2.01±1.10 and 1.86±0.69 respectively (total 54 379 samples).The total rates of anticoagulation complication and mortality were 5.79% Pty and 0.12% Pty respectively, among which the morbidity and mortality of hemorrhage were 3.59% Pty and 0.12% Pty respectively, while the morbidity and mortality of thromboembolism were 2.03% Pty and 0.00% Pty respectively. There are no significant differences of actual anticoagulation intensity (P=0.28)and the complication rates between the two hospitals .Conclusion The optimal intensity scope (INR) of 1.5-2.5 (mean 1.8-2.0) is safe and efficient for Chinese patients with prosthetic heart valves, and no significant regional difference in the intensity of anticoagulation therapy required.
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