中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

瓣膜置换术后患者行非心脏手术围术期不同抗凝方式的对比

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目的 总结心脏瓣膜置换术后患者行非心脏手术围手术期不同抗凝方式的疗效及对比术后出血相关并发症与栓塞相关并发症的发生情况。 方法 回顾性分析 2016 年 1 月至 2018 年 1 月就诊于我院的 56 例心脏瓣膜置换术后行非心脏手术患者的临床资料,根据患者围术期不同的抗凝方式分为桥接组(32 例)、非桥接组(24 例),对比两组患者术后住院天数、术后输血人数及出血相关并发症与栓塞相关并发症的情况。根据患者围术期的栓塞危险程度,将每组患者分为高危亚组、中危亚组、低危亚组,并比较两组患者中各亚组出血相关并发症与栓塞相关并发症的情况。 结果 桥接组在术后住院时间方面显著长于非桥接组,但桥接组在术后输血人数及总体的出血相关并发症与栓塞相关并发症方面与非桥接组无明显差异;根据患者围术期的栓塞危险程度对于两组进行亚组分析,非桥接组高危亚组出血相关并发症的发生率显著高于桥接组高危亚组;桥接组出血相关并发症与栓塞相关并发症的发生比率相近,而非桥接组出血相关并发症的发生比率是栓塞相关并发症的 7 倍。 结论 桥接抗凝会增加患者术后住院时间;但对于伴有栓塞高危因素的患者,围术期采用桥接抗凝更能使患者获益;继续口服华法林抗凝出血相关并发症的发生率显著高于其栓塞相关并发症的发生率,必要时需术前给予止血药物干预。

Objective To summarize the efficacy of different anticoagulation methods during perioperative period of non-cardiac surgery after cardiac valve replacement and to compare the complications of postoperative hemorrhagic-related complications and embolism-related complications. Methods Retrospective analysis of clinical data of 56 patients who underwent non-cardiac surgery after cardiac valve replacement in our hospital from January 2016 to January 2018 was conducted, according to different anticoagulation methods during perioperative period. The bridging group (32 patients) and nonbridging group (24 patients) were compared. The postoperative hospital stay, the number of postoperative blood transfusions, and hemorrhagic-related complications and embolization-related complications were compared between the two groups. According to the patient’s perioperative embolism risk, each group of patients were divided into high-risk subgroup, middle-risk subgroup, and low-risk subgroup, and the hemorrhagic-related complications and embolization-related complications in each subgroup were compared. Results The bridging group was significantly longer than the nonbridging group in terms of postoperative hospital stay, but there was no significant difference in the number of postoperative blood transfusions and overall hemorrhagic-related complications and embolization-related complications in the bridging group; Subgroup analysis was performed according to the degree of embolization risk in the perioperative period. The incidence of bleeding-related complications of the nonbridging group in the high-risk subgroup was significantly higher than that in the high-risk subgroup of the bridging group; The incidence of hemorrhagic-related complications in the bridging group was similar to that of embolization-related complications, while the rate of hemorrhagic-related complications in the nonbridging group was 7 times that of embolic-related complications. Conclusions Bridging anticoagulation increases the length of postoperative hospital stay,but for patients with high risk factors for embolization, it is more beneficial than continuing oral warfarin during the perioperative period. The incidence of hemorrhagic-related complications associated with continued warfarin therapy was significantly higher than that of embolism-related complications, and hemostatic drugs can be given necessarily.

关键词: 心脏瓣膜置换术后; 行非心脏手术; 围术期; 抗凝方式

Key words: Anticoagulation methods; perioperative period; non-cardiac surgery; after cardiac valve replacement

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