华法林联合肝素对瓣膜置换术后患者微循环的影响

目的:研究华法林联合肝素对瓣膜置换术后患者微循环的影响,评价其有效性及安全性。方法:选择2014年1月-2015年6月我院收治的瓣膜置换术患者60例,随机分为实验组和对照组,每组30例。对照组患者瓣膜置换术后第二天口服华法林治疗,实验组患者瓣膜置换术后当天即皮下注射低分子肝素钙,术后第二天口服华法林抗凝治疗。两组患者均于术后7 d、14 d空腹取外周静脉血,检测红细胞比容、血沉、全血还原比粘度、血浆比粘度以及红细胞聚集指数。结果:与对照组相比,实验组患者术后7d、14 d血沉值、全血比粘度水平、全血还原比粘度水平、血浆比粘度和红细胞聚集指数均显著降低,差异具有统计学意义(P0.05);两组患者术后7 d、14 d血细胞比容比较,差异无统计学意义(P0.05)。结论:和单独应用华法林相比,瓣膜置换术后采用联合应用华法林及肝素能更好改善患者微循环,值得临床推广。

The Observation of the Effect of Warfarin and Heparin on Microcirculation for Patients with Valve Replacement

Objective:To study the effect of warfarin and heparin on microcirculation for patients with valve replacement, and its effectiveness and safety.Methods:60 cases with valve replacement surgery who were treated in our hospital from January 2014 to June 2015 were chosen and randomly divided into the experimental group and the control group, with 30 patients in each group. The patients in the control group were treated with warfarin the next day after valve replacement surgery, while the patients in the experimental group were treated with subcutaneous low molecular weight heparin the same day at the valve replacement surgery, and warfarin administration at the second day. All the patients were taken fasting peripheral venous blood 7 d and 14 d after surgery. The hematocrit, ESR, whole blood reduced viscosity, plasma viscosity, and erythrocyte aggregation indexed of the two groups were detected and compared.Results:Compared with the control group, the ESR values, the level of whole blood viscosity, whole blood reduced specific viscosity level, plasma viscosity and erythrocyte aggregation index in the experimental group were significantly lower after surgery for 7 d and 14 d, and the differences were statistically significant (P<0.05). There was no statistically significant difference about the hematocrit in the two groups after the surgery for 7 d and 14 d.Conclusion:Compared with simple warfarin, warfarin and heparin on microcirculation can better improve microcirculation in patients, and it is worthy of promotion.