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目的:探讨心脏机械瓣膜置换术后行妇科手术患者抗凝治疗的方法。方法:回顾性分析我院心脏瓣膜置换术后行妇科手术30例患者的临床资料。患者入院后停用华法林,采用低分子肝素皮下注射替代治疗,术前12 h停用,术后12~24 h恢复低分子肝素治疗,同时口服华法林,根据凝血指标逐渐调整华法林至合适用量。记录患者围术期凝血指标变化、手术前后血红蛋白、术中出血量、深静脉血栓发生率等。结果:30例患者围术期通过低分子肝素替代华法林桥接治疗,凝血酶原时间及国际标准化比率均明显下降;18例刮宫手术患者手术前后血红蛋白比较差异无统计学意义,12例经腹手术患者手术前后血红蛋白比较差异有统计学意义,但无不可控制的出血发生;所有患者均未发现血栓形成和下肢深静脉血栓栓塞。结论:心脏瓣膜置换术后行妇科手术患者围术期应用低分子肝素替代华法林抗凝治疗是安全可行的,可有效控制出血和预防血栓形成。
Objective: To investigate the method of anticoagulant therapy in gynecological surgery patients after mechanical heart valve replacement. Methods: The clinical data of 30 patients undergoing gynecological surgery after heart valve replacement in our hospital were analyzed retrospectively. Patients were discontinued after admission warfarin, low molecular weight heparin subcutaneous injection replacement therapy, 12 h before surgery disabled, 12 to 24 h after the resumption of low molecular weight heparin therapy, oral warfarin, according to the coagulation index gradually adjusted Warfarin Lin to the appropriate amount. Changes in patients with perioperative coagulation indicators, before and after surgery, hemoglobin, blood loss, deep venous thrombosis and so on. Results: Thirty patients underwent percutaneous replacement of warfarin with low molecular weight heparin during the perioperative period. The prothrombin time and the international standardization rate were significantly decreased. There was no significant difference in hemoglobin before and after operation between 18 patients undergoing curettage and 12 patients undergoing transurethral resection The difference of hemoglobin before and after surgery was statistically significant, but no uncontrollable bleeding occurred. No thrombosis and deep venous thromboembolism were found in all patients. Conclusion: The application of low molecular weight heparin instead of warfarin anticoagulation in patients undergoing gynecological surgery after perioperative heart valve replacement is safe and feasible, which can effectively control bleeding and prevent thrombosis.