摘要
目的探讨人工机械心脏瓣膜置换术后华法林抗凝治疗的监测方法及相关并发症，初步研究华法林血浆浓度的临床意义。方法收集2005年6月至2006年5月人工机械瓣膜置换手术病例162例，随访至2006年12月31日，并记录并发症发生情况、INR值和华法林剂量。采用反相高效液相色谱法（high-performance iquid hroma-tographic，HPLC）测定华法林血浆浓度18例。结果①随访患者126例，随访时间7～19个月。随访中死亡6例（4．16％），与抗凝治疗有关的出血10例（7．94％），血栓栓塞3例（2．38％）。②抗凝后测得INR值为2．39±1．27，每日口服华法林剂量（3．19±1．43）mg。③测定华法林血浆浓度18例，其中INR值〈1．8者3例，1．8〈INR值〈2．5者10例，INR值〉2．5者5例。INR值〉2．5者华法林血浆平均浓度高于1．8〈INR值〈2．5者（P〈0．0005）。④INR值与相对应华法林血浆浓度无明显线性相关性（r=0．65，P〉0．1）；INR值与相对应每日口服华法林剂量之间亦无明显线性相关性（r=0．26，P〉0．2）。结论①华法林抗凝相关出血发生率高于血栓栓塞率。②华法林血浆浓度是一个抗凝监测指标。监测华法林血浆浓度，能指导临床医生安全有效地调整华法林剂量。
Objective To evaluate some methods to monitor anticoagulation therapy of warfarin. Methods 126 Cases of prosthetic heart valve replacement were collected from June 2005 to May 2006. Follow-up visit ended on 31st of December 2006 and recorded complications,INR value and warfarin dosage. 18 out-patient cases from our hospital were adopted HPLC to measure plas- ma concentrations of warfarin during September 2006. Results ①126 cases were visited, up for seven to nineteen months. Six cases（4.16%）died,ten cases （7.94%）were hemorrhage relating to anticoagulation,and three cases （2.38%）were thromboembolism. ②After anticoagulation meas- ured INR value is 2.39il. 27,daily close of warfarin is （3.19＋1.43）mg. ③Eighteen cases of plasma concentrations of warfain were measured,the observed INR values are as follows： three of them are smaller than 1.8（Group A） ,ten are larger than 1.8 and samller than 2.5（Group B） ,the rest five are larger than 2.5（Group C）. The average warfarin plasma concentrations of Group C is higher than that of Group B（P〈0.000 5）. @There is no obvious linear correlation between INR value and plasma concentrations（r=0.65, P〉0.1）, and there is also no obvious linear correlation between INR value and the amount of daily warfarin close taken（r=0.26,P〉0.2）. Conclusions ①Bleeding and thromboembolism which are relative to warfarin anticoagulation are the main complications after prosthetic heart valve replacement. The rate of bleeding is higher than that of thromboembolism. ②Plasma concentrations of warfarin is an index of anticoagulation monitoring, which can give clinicians advice to adiust the dosage of warfarin safely and effectively.
出处
《江西医学院学报》
CAS
2008年第2期76-80,共5页
Acta Academiae Medicinae Jiangxi
