二尖瓣(机械瓣)置换病人抗凝期间栓塞相关并发症的原因分析

Analysis of thrombosis-related events in mitral valve(mechanical valve) replacement patients

目的:探讨机械瓣置换患者抗凝期间血栓相关事件的发生原因和防治对策。方法:对瓣膜置换手术109例患者的临床资料进行回顾性分析。结果:9例栓塞相关事件者均为二尖瓣置换病人,其中院内急性瓣膜血栓形成1例,院内TIA6例,出院后脑栓塞2例。TIA病人的血浆纤维蛋白原含量较非TIA病人明显增高。结论:抗凝开始时间、抗凝的理想水平应依据对栓塞危险分析而定。血浆纤维蛋白原含量增高,容易促使病人发生TIA。应加强对高危患者尤其是华法令减量调整用药过程中的抗凝监测管理。

Objective：To evaluate the causes and control strategies of thrombosis in mitral valve （mechanical valve） replacement patients. Methods ：109 cases of valve replacement patients were retrospectively analyzed. Results ：All the 9 cases of thrombosis-related events were mitral valve replacement patients, one case of acute valve thrombosis, 6 cases of TIA, 2 cases of cerebral embolism. The plasma fibrinogen content in TIA patients was higher than that in non-TIA patients. Conclusion： The start time and optimal level of anticoagulation should be individualized. The Plasma fibrinogen content increasing can lead to TIA. High-risk patients Should be monitored strictly , especially during reducing dose process of warfarin adjustment.