目的 探讨心脏瓣膜置换术后的妇产科疾病患者再手术时抗凝药物的使用方法 及安全性.方法 15例心脏瓣膜置换术后患者,13例均为机械瓣膜置换,一直服用华法令抗凝.患者入院后均停用华法令,改为低分子肝素皮下注射,调整PT达到或接近正常后,于术前12小时停用抗凝药物.术后12～24小时口服华法令并与低分子肝素重叠使用,3～5日后停用低分子肝素.调整药物剂量,使INR达治疗目标范围.结果 15例心脏瓣膜置换术后因妇科疾病需再次手术患者,均顺利渡过围手术期,无任何并发症出现.结论 心脏瓣膜置换术后患者,再手术时只要合理调整抗凝药物种类、剂量及用法,掌握合适的抗凝强度,再次手术是安全的.%Objective To evaluation the application and safety of anticoagulation therapy in department of gynecology and obstetrics operation after heart valve replacement. Method In the 15 patients with heart valve replacement, there were 13 patients taking Warfarin continuous for anticoagulation therapy. Warfarin be stopped and Low-molecular-weight heparin (LMWH) be changed for all patients immediately for anticoagulation therapy when admission. All anticoagulant be stopped preoperative 12 hour. Both Warfarin and LMWH had been used in postoperative 12 to 24 hour. LMWH was stopped after postoperative 3 to 5 day. The dose of Warfarin was adjusted to make INR achieve therapeutic range. Results All patients of this group had passed through the before and later period of reoperation swimmingly and none complication had been found. Conclusion The patients with heart valve replacement undergo reoperation was safety, but in the before and later period of reoperation, the dose, kind and usage must be reasonable adjusted, the intensity anticoagulation therapy must be controlled.
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