小剂量尿激酶联合低分子肝素钙对合并左心耳血栓的经皮二尖瓣球囊成形术的疗效及安全性评价

The evaluation of the efficacy and safety of percutaneous balloon mitral valvuloplasty with left atrial thrombus in application of the thrombolysis and anticoagulation with low dose of urokinase and low molecular weight heparin

目的：探讨小剂量尿激酶（UK）联合低分子肝素钙（LWMH）的溶栓、抗凝技术在风心病二尖辫狭窄（MS）合并左心耳血栓患者行经皮二尖瓣球囊扩张术（PBMV）的疗效和安全性.方法：风心病MS合并左心耳血栓患者术前联合应用UK20万U,1次/d,低分子肝素钙4 100U,2次/d,连用5～7天后,停用2～3天再行PBMV,观察术前、术后出血、栓塞等主要并发症的发生率以及近、远期疗效.结果：173例行PBMV的患者中有106例为房颤患者,其中合并左心耳血栓者为28例,无1例发生术前、术中、术后严重出血、栓塞等主要并发症,术后心功能均明显改善达Ⅰ-Ⅱ级,其中14例患者房颤转为窦性心律.结论：术前应用小剂量UK联合LWMH的溶栓﹑抗凝技术在风心病MS合并左心耳血栓的患者行PBMV具有较高的安全性和显著疗效.

Objective ： To investigate efficacy and safety of the thrombolysis and anticoagulation with small dose of urokinase （UK） and low molecular weight heparin （LWMH） in rheumatic mitral stenosis （MS） patients with left atrial thrombus percutaneous balloon mitral valvuloplasty （PBMV）. Methods ： combination UK 20 million U times a day and low molecular weight heparin calcium 4100U,2 once a day for 5 ～ 7 days in rheumatic heart disease patients with thrombosis of the left atrial appendage before surgery , 2 ～ 3 days suspended again PBMV. Preoperative and postoperative hemorrhage, embolism and the incidence of major complications in the past, the long - term effect. Results ： 106 cases with atrial fibrillation in 173 patients with PBMV, thrombosis of the left atrial appendage which 28 cases without exception occurred before, during and after severe hemorrhage, embolism and other major complications. It reached significantly improved heart function after- grade, 14 patients with atrial fibrillation to sinus rhythm. Conclusion ： low- dose UK Joint LWMH before PBMV of thrombolysis and anticoagulation in rheumatic MS patients with left atrial thrombus was performed with significantly higher safety and efficacy.