风湿性心脏病二尖瓣狭窄患者并发左房活动性血栓危险因素分析及肝素钠的治疗效果观察

The correlation between left atrial active thrombosis and asymptomatic cerebral infarction in patients with rheumatic heart disease complicated with mitral stenosis and the therapeutic effect of low molecular weight heparin

目的:探讨风湿性心脏病二尖瓣狭窄患者并发左房活动性血栓危险因素及肝素钠的治疗效果。方法:回顾性分析159例风湿性心脏病并发二尖瓣狭窄的临床资料,根据其是否并发左房活动性血栓,分为血栓组( n=96)和无血栓组(n =63)。采用单因素分析和多因素Logistic回归分析法对风湿性心脏病并发二尖瓣狭窄患者出现左房活动性血栓的危险因素研究。另将血栓组患者按照是否进行肝素钠治疗分为观察组和对照组,每组各48例。对照组患者给予阿司匹林以及华法林治疗,观察组患者在上述治疗基础上肝素钠治疗。观察两组患者治疗前后的凝血功能变化,比较两组患者不良反应发生情况及临床治疗效果。结果:对风湿性心脏病并发二尖瓣狭窄患者并发左房活动性血栓的多因素Logistic回归分析结果显示,血栓发现年龄、MVO、无症状脑梗死以及明显MR例数是其独立危险因素( P =0.003,0.028,0.040,0.016)。与治疗前相比,两组患者的PAR值明显降低,APTT和PT值明显升高,且观察组患者凝血功能改善更为显著( t/P =8.150/<0.001,19.153/<0.001,7.859/<0.001)。观察组患者出血发生率高于对照组,其他不良反应发生率低于对照组;总发生率低于对照组,差异具有统计学意义(χ 2/ P =7.940/0.005)。观察组患者的治疗有效率为93.75%,明显高于对照组的66.67%,差异具有统计学意义(χ 2/ P =11.090/0.001)。结论:风湿性心脏病并发二尖瓣狭窄患者出现左房活动性血栓的独立危险因素为年龄、MVO、无症状脑梗死以及明显MR例数;肝素钠干预后,可以明显改善减轻左房活动性血栓情况,减少不良反应发生情况,增加临床治疗效果。

Objective: To investigate the correlation between left atrial active thrombosis and asymptomatic cerebral infarction in patients with rheumatic heart disease and mitral stenosis,as well as the therapeutic effect of low molecular calcium. Methods: The clinical data of 159 cases of rheumatic heart disease complicated with mitral stenosis were retrospectively analyzed.According to whether they were complicated by left atrial active thrombosis,they were divided into two groups:thrombus group( n =96) and non-thrombosis group( n =63).Univariate analysis and multivariate logistic regression analysis were used to study the risk factors of left atrial active thrombosis in patients with rheumatic heart disease complicated with mitral stenosis.In addition,patients with thrombosis were divided into observation group and control group according to whether or not to perform low molecular weight heparin treatment,48 cases in each group.The control group was treated with aspirin and warfarin,and the patients in the observation group were treated with low molecular weight heparin on the basis of the above treatment.The coagulation function changes of the two groups before and after treatment were observed,and the adverse reactions and clinical treatment effects of the two groups were compared. Results: Multivariate logistic regression analysis of patients with rheumatic heart disease complicated with mitral stenosis complicated with left atrial active thrombosis showed that age of thrombosis,MVO,asymptomatic cerebral infarction and significant MR cases were independent risk factors( P =0.003,0.028,0.040,0.016).Compared with afore treatment,the PAR values of the two groups were significantly lower,the APTT and PT values were significantly increased,and the coagulation function of the observation group was significantly improved( t/P =8.150/<0.001,19.153/<0.001,7.859/<0.001).The incidence of bleeding in the observation group was higher than that in the control group,and the incidence of other adverse reactions was lower than that in the control group.The total incidence was lower than that in the control group,and the difference was statistically significant(χ 2/ P =7.940/0.005).The effective rate of treatment in the observation group was 93.75%,which was significantly higher than that in the control group(66.67%),the difference was statistically significant(χ 2/ P =11.090/0.001). Conclusion: Independent risk factors for left atrial active thrombosis in patients with rheumatic heart disease complicated with mitral stenosis are age,MVO,asymptomatic cerebral infarction and significant MR cases.After intervention with low molecular weight heparin,it can significantly improve the reduction of active atrial thrombus,reduce the incidence of adverse reactions,and increase the clinical treatment effect.