摘要
目的探讨华法林血浆药物浓度的动态变化在心脏机械瓣膜置换术后抗凝监测中的临床意义。方法随机选择 30例风湿性心脏病行机械瓣膜置换术的患者 ,同步测定华法林血浆药物浓度、国际标准比值(internationalnormalizedratio ,INR)、凝血酶原时间 (prothrombintime ,PT)和华法林服用剂量的动态变化 ,同时观察抗凝并发症的发生情况。结果①血浆华法林药物浓度在口服首剂量华法林后 2h即明显升高 (P <0 .0 5 ) ,6h达高峰 (P <0 .0 1 ) ,72h后趋于稳定。②INR和PT在服用首剂量华法林 36h后才呈现显著变化 (P <0 .0 5 ) :INR显著增加 ,PT明显延长。 72h后 ,INR和PT呈现非常显著变化 (P <0 .0 0 1 )并趋于稳定。③华法林血浆药物浓度与INR、PT无显著相关性 ,相关系数分别为 0 .2 74和 0 .2 76 ,P均 >0 .0 5。华法林血浆药物浓度的对数值与INR及PT在 36h后呈显著正相关 ,相关系数分别为 0 .894和 0 .90 8(P均 <0 .0 0 1 )。结论华法林血浆药物浓度灵敏而稳定 ,可以用作口服抗凝剂的监测指标 ;其与INR及PT等抗凝监测指标结合有助于提高抗凝监测的准确性 。
ObjectiveTo study the clinical significance of warfain plasma concentration in oral anticoagulation monitoring following mechanical heart valve replacement.MethodsThirty patients following mechanical heart valve replacement were chosen randomly.They all had rheumatic heart disease.Plasma concentration of warfarin,international normalized ratio (INR),prothrombin time (PT) and oral dosage of warfarin were determined respectively.Changes and correlationships of all the above indexes were compared before and after taking warfarin.At the same time,the clinical complications,such as blooding and thromboembolism were observed.Results① The warfarin plasma concentration increased significantly at the time point of 2 hours after initial dose administration of warfarin (P< 0.05 ).It reached peak at 6 hours (P< 0.01 ) and tended to remain constant after 72 hours.② After the initial dose of warfarin,there were not significant changes of INR and PT until 36 hours (P< 0.05 ).At 36 hours,INR increased greatly and PT prolonged significantly.72 hours later,INR and PT had very significant difference compared with 0 hour (P< 0.001 ) and tended to remain constant.③ There were not significant correlationships between warfarin's plasma concentration with INR and PT.The correlation coefficient were 0.274 and 0.276 respectively (P> 0.05 ).However,analysis showed a significant relationship between the logarithm of the warfrain concentration with INR and PT after 36 hours.The correlation coefficient were 0.894 and 0.908 (P< 0.001 ).ConclusionsThe plasma concentration of warfarin was a sensitive index in monitoring anticoagulation; the combination of warfarin plasma concentration with INR and PT would improwe the precision of anticoagulation and decrease complications.
出处
《河北医科大学学报》
CAS
2003年第4期193-196,共4页
Journal of Hebei Medical University