应用抗凝剂的心脏瓣膜置换患者接受胆道手术的术前处理

Preoperative management of anticoagulated valve replacement patient undergoing selective biliary tract surgery

目的总结瓣膜置换患者行胆道手术的术前用药方法。方法对38例瓣膜置换后在服用华法令过程中因胆道疾病需行择期手术治疗的患者随机分为2组,肝功能正常组(A组)23例、肝功能不正常组(B组)15例均于术前3d停服华法令,B组术前12h肌注VitK110mg。术前无应用华法令历史的患者115例做为对照组。结果38例患者停药2d后A组血浆凝血酶原时间与对照组差异无显著意义,B组于术前12h肌注VitK110mg后,血浆凝血酶原时间与对照组相比差异也无显著性意义。结论瓣膜置换患者在抗凝期间行胆道手术,只要准备充分,围手术期是安全的。

Objective To sum up our experience in the preoperative management for anticoagulated valve replacement patients undergoing selective biliary tract surgery Methods Thirty eight patients were divided into normal liver function group of 23 cases (group A) suspending anticoagulant 3 days before the surgery and group B of 15 cases with abnormal liver function suspending anticoagulant plus VitK 1 injection 12 hours before the surgery Prothrombin time was measured, and result was compared with 115 normal controls Results There were no significant difference in prothrombin time between the two groups Conclusion A biliary tract surgery could be safe if anticoagulated patients receive adequate preoperative management