风湿性心脏病并左心房血栓患者瓣膜置换术后的抗凝治疗

Anticoagulation therapy after cardiac valve replacement for patients with rheumatic heart disease combined with left atrial thrombus

目的 探讨风湿性心脏病并左心房血栓患者行瓣膜置换术后血栓形成的相关因素 ,总结术后抗凝治疗经验。方法 随诊 18例风湿性心脏病并左心房血栓行瓣膜置换术的患者 ,监测血凝指标 ,术后半年复查超声心动图测量左心房内径。另选取同期 47例风湿性心脏病无左心房血栓行瓣膜置换术的病人作对照。比较两组病人术后血栓发生率。结果 血栓组 ( 组 )术后血栓发生率为 2 2 .2 % ,明显高于对照组 ( 组 ) ( P<0 .0 5 ) ,呈显著性差异 ,但凝血酶原时间 ( PT)和国际标准化比率 ( INR)与对照组比较均无显著性差异 (分别为 P>0 .10 ,P>0 .10 )。血栓组术后半年左心房内径明显大于对照组 ( P<0 .0 1) ,术后心房颤动发生率也明显高于非血栓组 ( P<0 .0 1)。结论 对于风湿性心脏病合并左心房血栓的患者 ,瓣膜置换术后 ,抗凝治疗应注意调整 PT和 INR稍高于常规标准 。

Objective To investigate the relative factors of thrombosis after cardiac valve replacement for patients with rheumatic heart disease (RHD) combined with left atrial thrombus, and to sum up the experience of anticoagulation therapy after operation. Methods 18 patients with RHD and left atrial thrombus (GroupⅠ) were followed-up after cardiac valve replacement, and the hematologic determinations including prothrombin time (PT) and International Normalized Ratio (INR) were detected every time, and the diameters of the left atrium were measured using ultrasound cardiogram 6 months postoperatively. Another 47 patients (without left atrail thrombus) who underwent cardiac valve replacement at the same time of period, were observed as a control group (GroupⅡ). The thromboembolism rates were investigated respectively. Results The thromboembolism rate was 22.2% in groupⅠ, and it was higher than that in groupⅡ( P <0.05), but there was no significant difference in PT and INR between the two groups ( P>0.10,P >0.10 respectively). Compared with groupⅡ, the diameter of the left atrium is larger ( P <0.01), and the incidence of atrial fibrillaton is also higher ( P <0.01). Conclusion For the patients with RHD combined left atrial thrombus, the anticoagulation therapy is more important, PT and INR should be adjusted slightly higher than normal standard. The thrombolytic therapy is a simple but effective method for treatment of thromboembolism after cardiac valve replacement.