农村偏远地区心脏瓣膜置换术后的抗凝治疗

The anticoagulant therapy for the patients with mechanical heart valve prostheses from remote village

目的观察农村偏远地区心脏瓣膜置换术后的抗凝治疗,为农村偏远地区换瓣患者提供一种简单可行的抗凝方法。方法近3年30名农村偏远地区换瓣患者（观察组）与31名城镇换瓣患者（对照组）术后抗凝,口服华法林片,剂量根据凝血酶原时间（PT）、国际标准化比（INR）调整,观察组的抗凝监测间隔时间较对照组延长,抗凝强度一样。同时进行抗凝的宣教。结果 61例患者中测得INR共742次,其中观察组329次,对照组413次,INR控制在1.5-2.0的596次。住院期间两组患者无严重出血及栓塞并发症,出院后观察组1例1月后出现感染性心内膜炎死亡,2例牙龈出血,4例月经过多。对照组2例牙龈出血,3例月经过多。结论采用INR 1.5-2.0抗凝治疗强度是安全可靠的,通过加强抗凝的宣教,适当延长检测间隔时间的方法并不影响换瓣术后中短期抗凝效果。

Objective To observe the effect of oral anticoagulant therapy on patients with mechanical heart valve prostheses and to provide a simple and feasible anticoagulant therapy for patients from remote village.Methods 30 patients from remote village（experimental group） and 31 patients from city（control group） underwent mechanical heart valve replacement in recent 3 years were involved in the study.The dose of warfarin tablet was adjusted according to the prothrombin time（PT） and international normalized ratio（INR） when warfarin taken for anticoagulation.The interval time of anticoagulation in experimental group was properly prolonged comparing with control group.Knowledge of anticoagulation was educated to patients.Results A total of 742 blood specimens from 61 patients of INR were tested,in which 413 cases in control group and 329 in experimental group.596 cases of INR were controlled within 1.5 - 2.0.There was no severe complication of hemorrhage and embolism between the two groups in hospital.One case died of infective endocarditis a month later post-discharge,2 cases showed gingival bleeding and 4 with hypermenorrhea in experimental group.2 cases showed gingival bleeding and 3 with hypermenorrhea in control group.Conclusion It＇s safe and reliable to anticoagulate according to the uniform standard intensity within the range of INR of 1.5~2.0.It could not affect the short and mid-half term anticoagulant effect when the interval time of anticoagulant monitoring properly prolonged with the help of anticoagulant education.