Objective To explore the effect of peri-operative anticoagulation of orthopaedic surgery among patients who had a previous cardiac mechanical valvereplacement.Methods Fifty patients with artificial cardiac valve who underwent orthopaedic surgery were retrospectively studied.Warfarin was replaced by continuous low molecularweight heparin(LMWH) 3 days before operation.LMWH was started 24 hours after operation.Warfarin was taken 48 hours after operation.LMWH was stopped when International Normalized Ratio exceeded 1.5.Warfarin should be regulated to reasonable dosage.The peri-operative bleeding,whether the valve had thrombosis,whether the normal valve function was good and the incidence of deep venous thrombosis were recorded.Results In 50 patients,the peri-operative bleeding was 200-550 ml,the average was (320 ± 75)ml.There was no serious postoperative bleeding and five cases had hyporrhea.No embolism was found in the valve and deep veins of lower limb.Compared with preoperative data,the hemoglobin at 4,10 days after the operation was not significantly changed[(117 ±11),(118±12)g/L vs (120±9)g/L,P＞0.05].Conclusion LMWH can be used for perioperative anticoagulation in patients with a history of cardiac valve replacement before orthopaedic surgery.%目的 探讨心脏机械瓣膜置换术后行骨科手术患者围术期抗凝治疗的方法.方法 回顾性分析1998年10月至2014年10月首都医科大学附属北京安贞医院人工心脏机械瓣膜置换术后行骨科手术的50例患者临床资料.患者术前3d开始停用华法林,采用1 mg/kg低分子肝素替代治疗,皮下注射,1次/12 h,术前12h停用,术后24h开始恢复使用低分子肝素,术后48 h开始口服华法林,凝血酶原时间国际标准化比值大于1.5时停用低分子肝素,逐渐调整华法林至合适用量.记录患者围术期出血量、卡瓣率(超声心动复查是否有瓣膜血栓形成,瓣膜功能是否正常)和深静脉血栓发生率,比较患者手术前后血红蛋白水平.结果 50例患者术中出血量为200 ～ 550 ml,平均(320±75) ml;术后引流量为380～ 750 ml,平均(580±85)ml.术后5例患者出现出血,给予相应治疗后好转.所有患者未发现瓣膜血栓形成和下肢深静脉血栓.术前与术后第4、10天的血红蛋白比较,差异无统计学意义[(120±9)g/L比(117±11)、(118±12)g/L,均P＞0.05].结论 心脏瓣膜置换术后行骨科手术患者围术期应用低分子肝素替代华法林抗凝治疗可有效防止大量失血、卡瓣、深静脉血栓形成等严重并发症.
展开▼
