肠溶阿司匹林和肝素联合抗凝治疗中出现腹膜后血肿

Retroperitoneal hematoma occurring during anticoagulant therapy with enteric-coated aspirin plus heparin

1例69岁冠心病、高血压女性患者服用卡托普利、阿替洛尔、硝酸异山梨酯及硝苯地平治疗2年余。入院后,患者因不稳定心绞痛加用肠溶阿司匹林0.1 g,1次/d和低分子肝素钙5 000 U,1次/12 h皮下注射。第2天,肠溶阿司匹林增加至0.3 g,1次/d;低分子肝素钙改为肝素钠800～1 500 U/h,静脉泵入。48 h后再次改为低分子肝素钙6 000 U,1次/12 h皮下注射。第5天,患者出现腹膜后血肿,出血量约1 000～1 200 ml。停用肠溶阿司匹林和低分子肝素钙,给予悬浮红细胞、巴曲酶及扩容治疗。入院第28天,CT检查示患者血肿有所吸收,2 d后出院。出院2个月CT复查示出血肿大部分吸收。

A 69-year-old woman with coronary heart disease and hypertension received captopril, atenolol, isosorbide dinitrate, and nifedipine for two years and more. After admission, enteric-coated aspirin 0.1 g once daily and SC low molecular weight heparin calaium 5 000 U once every 12 hours were added to her regimen due to unstable angina. The next day, her enteric-coated aspirin dosage was increased to 0.3 g once daily, and low molecular weight beparin calcium was changed to heparin sodium 800-1 500 U/h, which was administered via an intraveous infusion pump. Forty-eight hours later, heparin sodium was switched to SC low molecular weight heparin calcium 6 000 U once every 12 hours again. On day 5, the patient developed retroperitoneal he matoma, and the amount of bleeding was 1 000-1 200 ml. Enteric-coated aspirin and low molecular weight heparin calcium were withdrawn. RBC suspension, batroxobin, and fluid expansion were given. On day 28 after hospitalization, a CT scan revealed that his hematoma was absorbed in some degree and she was discharged two days later. Two months after discharge, repeated CT scan showed that a greater part of hematoma was absorbed.