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目的:观察围术期持续应用华法林抗凝治疗对急诊永久心脏起搏器植入术后囊袋血肿发生率的影响。方法分析2005年1月—2016年1月我院急诊入院的156例老年房颤患者,均伴有不同程度房室传导阻滞或长间歇,需紧急植入永久心脏起搏器。其中31例服用华法林,70例未服用任何抗凝治疗,分别为抗凝组和未抗凝组。持续应用华法林组患者给予围术期内监测凝血酶原国际化比值(INR),并维持华法林治疗(华法林剂量1.5—6.0mg),不调整华法令剂量,并根据INR值,将抗凝组分为A组<2.0,B组2.0-3.0,C组>3.0.分别观察起搏器植入术后囊袋血肿发生率。结果持续应用华法林组囊袋血肿发生率为6.45%(2/31),未抗凝组为5.71%(4/70),两组比较差异没有统计学意义(P>0.05)。结论急症围术期继续服用华法林是可行的,不会增加起搏器植入术后囊袋血肿发生率。
OBJECTIVE: To observe the effect of perioperative continuous warfarin anticoagulation on the incidence of capsular hematoma after emergency cardiac pacemaker implantation. Methods From January 2005 to January 2016, 156 cases of elderly AF patients admitted to our hospital were accompanied by varying degree of atrioventricular block or intermittent long-term rest. Permanent cardiac pacemakers were implanted urgently. Among them, 31 patients took warfarin, and 70 patients did not take any anticoagulant therapy. They were anticoagulant group and non-anticoagulation group respectively. Patients in the continuous warfarin group were given perioperative monitoring of Prothrombin Internationalization Ratio (INR) and warfarin treatment (warfarin dose 1.5-6.0 mg), no warfarin dose adjustment, and INR value , The anticoagulant group A group of <2.0, B group 2.0-3.0, C group> 3.0, were observed after implantation of pacemaker pouch hematoma incidence. Results The rate of cyst hematoma in continuous warfarin group was 6.45% (2/31) and that in non-anticoagulant group was 5.71% (4/70). There was no significant difference between the two groups (P> 0.05). Conclusions Continued administration of warfarin in acute perioperative period is feasible and does not increase the incidence of pouch hematoma after implantation of pacemaker.