张志宏,覃军,黄岚,李隆贵,宋耀明,耿召华,高凌云,林春梅,陶春蓉

• 1:第三军医大学新桥医院全军心血管病研究所

摘要(Abstract)：

目的评价房间隔缺损封堵术后不同抗凝方案的安全性及疗效。方法 56例房间隔缺损患者分入三组并于封堵术后给予不同抗凝方案:即肝素组(16例)持续静滴肝素钠10U.kg-1.h-1、共24h;低分子肝素组(20例)腹壁皮下注射依诺肝素1mg/kg、每12h1次,共2次和延长低分子肝素组(20例)依诺肝素用法用量同低分子肝素组、但术后连续使用3天,共6次。三组均于封堵术前2天起口服阿司匹林3mg·kg-1.d-1,至术后6个月。封堵术后三组均临床随访3个月,并于术后第30、90天复查经胸心脏超声;术后第4天测定活化部分凝血活酶时间(APTT);术后第4、7、30和90天测定血浆β-血小板球蛋白(β-TG)、血小板第4因子(PF4)和凝血酶原片段1+2(F1+2)浓度。结果 (1)封堵术后三组均无封堵器血栓形成和严重出血并发症,术后第4天三组APTT均在正常参考值范围内;(2)术前三组间β-TG、PF4和F1+2浓度差异均无统计学意义(P>0.05)。术后第4天,低分子肝素组β-TG、PF4和F1+2浓度与肝素组相比差异均无统计学意义(P>0.05),延长低分子肝素组β-TG浓度较肝素组低16%(P<0.05)、与低分子肝素组相比差异无统计学意义(P>0.05),PF4浓度较肝素组和低分子肝素组差异均无统计学意义(P>0.05),F1+2浓度较肝素组低8%(P=0.018)、较低分子肝素组低11%(P=0.035);(3)术后第7、30和90天,三组间β-TG、PF4和F1+2浓度差异均无统计学意义(P>0.05)。结论与肝素相比,低分子肝素用于房间隔缺损封堵术后抗凝两者安全性及疗效相当,延长低分子肝素疗程至术后第3天有利于降低房间隔缺损封堵术后血栓形成风险,且不增加出血风险。

关键词(KeyWords)： 房间隔缺损;封堵;抗凝;肝素;肝素,低分子量

Abstract:

Keywords:

基金项目(Foundation): 重庆市重点攻关课题(cstc,2009AB5033)

作者(Author): 张志宏,覃军,黄岚,李隆贵,宋耀明,耿召华,高凌云,林春梅,陶春蓉

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