心脏瓣膜置换术凝血功能变化及对华法林出血不良反应的监测

Blood coagulation changes of heart valve prostheses patients and monitoring of bleeding side effects of warfarin

目的 通过检测心脏瓣膜置换术患者凝血功能的变化,对华法林的抗凝效果及不良反应进行监控。方法对157例心脏瓣膜置换术患者术前、术后3d、5d、7d、14d、1月、3月的凝血功能,包括凝血酶原时间（PT）、国际正常化比率（INR）、活化部分凝血酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）、抗凝血酶Ⅲ（AT-Ⅲ）、D-二聚体（D-D）进行持续的监控,并对其门诊随访进行出血、未出血分组比较。结果 指标中患者术后PT（INR）、APTT延长明显;时间上患者术后3～5dPT（INR）、APTT逐步延长（P〈0.05）,PT从（16.3±1.6）s升高到（18.2±2.0）s,INR从（1.36±0.13）升高到（1.52±0.17）,第7d,PT（INR）、APTT分别达到为（24.4±1.8）s（2.03±0.15）、（37.2±3.53）s,较术前显著延长（P〈0.01）。术后3个月凝血功能随访发现,与未出血组比较,出血组PT（INR）延长差异非常显著（P〈0.01）,APTT延长差异显著（P〈0.05）。结论 心脏瓣膜置换术患者术后PT（INR）、APTT可作为华法林的抗凝效果及不良反应监测的重要指标。

Objective To observe blood coagulation changes of heart valve prostheses patients and explore antico- agulation effects and side effects of warfarin. Methods Blood coagulation of 157 patients before valve prostheses, 3 days, 5 days, 7 days, 14 days, 1 month and 3 months after valve prostheses were detected, including prothromhin time （PT）, international normalized ratio （INR）, activated partial thromboplastin time （APTT）, thromhin time （TT）, fibrinogen （FIB）, antithrombin Ⅲ （AT- Ⅲ ） and D-dimer （D-D）. The patients were fallowed-up. Results PT（INR） and APTT of the patients increased after operation. PT 3 and 5 days after operation were 16.3：kl. 6s and 18.2±2.0s. INT 3 and 5 days after operation were 1.36±0.13 and 1.52±0.17. PT（INR） and APTT 7 days after operation were （24.4± 1.8）s（2.03±0.15） and（37.2±3.53）, which was longer than that before operation. 3 months after fallow-up, PT（INR） and APTT of bleeding group were longer than that of non-bleeding group （P〈0.01）. Conclusion PT （INR） and APTT of patients with heart valve prostheses can he key indicators of warfarin anticoagulant effects and side effects.