摘要
机械瓣替换术后均需抗凝治疗，因此患者的凝血机制处于异常状态，当再次接受体外循环手术时对肝素的反应与一般患者不同。曾发现，２例肝素常规用量（４００Ｕ／ｋｇ），术中术后渗血和输血量较一般患者明显增多。此后，对这类患者采用小剂量肝素（２４０Ｕ／ｋｇ）抗凝，情况明显改善。但其中１例急性心内膜炎患者则表现明显的肝素耐药，所以必须密切监测全血凝固时间，既要确保体外循环的安全实施，又要避免抗凝过度。
Fifteen patients had been treated with anticoagulant warfarin for a long time after mechanical valve replacement. During re-operation,It was found that the average ACT was increased to 955±488 sec in two patients when a routine dose of 400 U/kg of heparin was given.The volumes of blood loss, blood transfusion and chest drainage during and after operation were much more than ordinary cases.But in the remaining 12 cases as heparin was reduced to 240 U/kg, average ACT was 803±635 sec and blood loss was decreased.It has been reported that warfarin not only depresses the synthesis and activity of some coagulation factors,but also increases AT-III content and activity. Patients pretreated with warfarin may be more sensitive to heparin than usual,1/2-2/3 of the routine dosage of heparin may be enough. However,one patient of acute bacterial endocarditis with high fever showed heparin resistance,a total amount of heparin as high as 507 U/kg was needed for emergency operation.
出处
《中国循环杂志》
CSCD
1994年第4期229-231,共3页
Chinese Circulation Journal
关键词
肝素
人工心瓣膜术
再手术
抗凝血药
Mechanical valve replacement
Anticoagulation
Warfarin
Heparin
