活化凝血时间监测对心脏瓣膜置换术患者低分子肝素剂量及伤口引流量的影响

摘要

目的：探讨活化凝血时间（ACT）监测对心脏瓣膜置换术患者低分子肝素剂量及伤口引流量的影响。方法将医院心血管外科体外循环下行心脏瓣膜置换术的100例患者随机分为对照组和观察组，各50例。两组患者均给予低分子肝素抗凝，对照组未行ACT监测，观察组行ACT监测。结果术后10 h，观察组引流量和悬浮红细胞输入量均明显低于对照组（ P﹤0.05）；两组患者凝血酶原时间（PT）较术前均明显延长，组间比较，差异无统计学意义（ P﹥0.05）；对照组患者部分活化凝血酶原时间（APTT）较术前明显延长（ P﹤0.05），观察组无显著变化（ P﹥0.05），对照组较观察组明显延长（ P﹤0.05）；术后24 h，两组患者PT较术前无明显差异，但对照组APTT仍较术前明显延长（ P﹤0.05），且显著长于观察组（ P﹤0.05）；观察组不良反应发生率显著低于对照组（ P﹤0.05）。结论体外循环下心脏瓣膜置换术后行ACT监测，能适时调整低分子肝素使用剂量，有助于减少伤口平均引流量和悬浮红细胞输入量，同时也减少APTT等指标波动和出血等不良反应的发生，值得临床推广。%Objective To investigate the influence of activated coagulation time (ACT) monitoring on the low molecular weight heparin dosage and wound drainage after cardiac valve replacement. Methods 100 cases of patients with cardiac valve replacement surgery un-der extracorporeal circulation in the hospital were randomly divided into the control group and the observation group,50 cases in each group. The two groups were given low molecular weight heparin;the observation group performed ACT,and the control group did not perform ACT. Results 10 h after operation,the amount of suspended red blood cells in the observation group were significantly lower than those in the control group( P ﹤ 0. 05). PT was significantly longer in the two groups than before operation,but with no statistical difference between the two groups( P ﹥ 0. 05);APTT was significantly longer in the control group( P ﹤ 0. 05),and had no obvious change in the observation group( P ﹥ 0. 05),the control group was obviously longer than the observation group( P ﹤ 0. 05). 24 h after operation,the PT in the two groups had no obvious difference compared with before,but APTT in the control group was still longer than before( P ﹤ 0. 05),and significantly longer than the observation group( P ﹤ 0. 05);the incidence rate of adverse reactions in the control group was significantly higher than that in the observation group( P ﹤ 0. 05). Conclusion ACT monitoring after cardiac valve replacement under extracorporeal circulation can adjust the dosage of low molecular weight heparin,is conducive to reducing the average wound drainage and suspended red blood cell input,while also reducing the occurrence of fluctuations in indicators such as APTT and adverse reactions such as bleeding,and is worth of clinical promotion.