瓣膜置换术后抗凝治疗中血浆D-二聚体、纤维蛋白原的观察及临床意义

The Observation and Clinical Significance of the D-dimer,Fibrinogen in Plasma during Anticoagulation Treatmentafter Mechanical Heart Valve Replacement

目的 :探讨测定血浆D -二聚体、纤维蛋白原的含量来监测机械瓣膜置换术后抗凝的可行性。方法 :应用速率散射比浊法和酶联免疫吸附法测定术前、术后 1周、 2周、 3周、 1个月、 2个月、 3个月 7个时点的凝血酶原时间比值、D -二聚体、纤维蛋白原。并根据PTR <1 4或 >1 4将病例分为 2组。结果 :随着抗凝时间的增加 ,抗凝强度在逐渐的加强。更高的抗凝强度可以导致血浆D -二聚体水平更快的下降。结论 :①人工心脏机械瓣膜置换术后 ,华法林抗凝治疗应个体化。②血浆D -二聚体含量可以预测血栓的形成。③机械瓣膜置换术后 3个月内抗凝治疗应更加谨慎 ,抗凝的监测应比较频繁。

Objective:To explore the possibility of using D-dimer,fibrnogen in plasma to monitor the anticoagulation after mechanical heart valve replacement. Methods: The rate nephelometry and ELISA were adopted to measure the value of prothrombin time ratio, D dimer, and fibrinogen. The patients were divided into two group according PTR<1 4 or PTR>1 4.The blood samples were collected on the preoperative, the first,second,third week after operation and the first, second,third postoperative month.Results: While the duration of anticoagulation increases, the anticoagulation intensity enhances. Higher anticoagulation intensity could lead to faster decrease of D dimer.Conclusion:①The anticoagulation treatment of warfarin should be individulized after the mechanical valve replacement.②The concentration of D-dimer in plasma can predict the clot formation during the anticoagulation.③The anticoagulation treatment should be more meticulous during the first three month postoperatively.④This study reconfirms the INR is much better than PTR .