人工机械瓣膜替换围术期凝血功能改变及抗凝治疗

The Changes in Coagulation System and the Choice of Optimal Anticoagulation Intensity during Perioperative Period in Patients with Mechanical Prosthetic Valve Replacement

为探讨人工机械瓣膜围术期合理抗凝治疗， 减少血栓栓塞与抗凝出血并发症， 对４０ 例患者术前、术中及术后第１、３、７、１５ ｄ 凝血酶原时间（ＰＴ）、血浆凝血因子Ｘ活性、抗凝血酶Ⅲ（ＡＴ Ⅲ）、Ｄ－二聚（Ｄ－ｄｉｍ ｅｒ）、纤维蛋白原含量（Ｆｇ） 及血浆血小板α颗粒蛋白（ＧＭＰ－１４０） 改变进行了动态监测。研究结果： 体外循环期间及术后早期， 出现大量血小板破坏、多种凝血因子减少、抗凝血酶Ⅲ水平降低， 同时伴有继发性纤溶活性增强。讨论了引起凝血功能异常的因素以及围术期及时抗凝治疗并适当提高抗凝强度的意义。

To evaluate the optimeal target anticoagulation intensity and reduce the risk of thromboemboli and bleeding during perioperation after mechanical heart valve rephacement, hematologic assays including prothrombin time (PT), activity of factor X, antithrombin Ⅲ, D dimer, fibrinogen (Fg), platelet alpha granular membrane protein (GMP 140) were performed before operation, during cardiopulmonary bypass, and at the postoperative day 1,3,7 and 14 in 40 patients receiving warfarin treatment. The results showed the damage to platelet, a decrease of factor X and At Ⅲ level, and an increase of D dimer and Fg, indicating disorder of the coagulation system and secondary fibrinolysis activation. The reasons for disorder of coagulation system and the implication of increasing anticoagulation level in the first few days after mechanical heart valve replacement were discussed.