Zheng Jia,Li Zhongzhi,Li Xiaofeng,et al.Prevention of thrombosis after total cavopulmonary anastomosis:a singlecenter study.[J].Journal of Clinical Pediatric Surgery,2018,17(05):354-357.
不同方法预防全腔静脉-肺动脉吻合术后血栓的单中心研究
- Title:
- Prevention of thrombosis after total cavopulmonary anastomosis:a singlecenter study.
- 关键词:
- 全腔静脉肺动脉吻合术; 血栓形成; 阿司匹林; 华法令
- Keywords:
- Total cavopulmonary anastomosis; Thrombosis; Aspirin; Warfarin
- 文献标志码:
- A
- 摘要:
- 目的 本研究旨在探讨华法令和阿司匹林对全腔静脉-肺动脉吻合术（Fontan手术）后血栓形成的预防作用。 方法 本院自2004年2月至2016年12月共实施Fontan手术37例，患儿年龄3.5 ~ 12岁，平均年龄(7.32 ± 2.25)岁。体重11.5 ~ 41 kg，平均体重（23.58 ± 4.25） kg。均无房颤等并发症。依据预防血栓的方法分为华法林组和阿司匹林组，华法林组14例，初始剂量为0.06 mg﹒kg-1﹒d-1，调整剂量时按0.01 ～ 0.02 mg﹒kg-1﹒ d-1，逐渐加量或者减量，目标INR值为1.5～2.0；阿司匹林组23例，按5 mg·kg-1·d-1口服。结果 华法令组术后即刻至3 d总引流量（17.33 ±5.62）mL/kg，阿司匹林组（19.27 ± 6.49）mL/kg，差异无统计学意义（t = 0.305，P = 0.633）。华法令组输血量（15.18 ± 4.73）mL/kg，阿司匹林组输血量（13.52 ± 3.29）mL/kg，差异有统计学意义（t = 0.718，P = 0.452）。3年内发生血栓事件：华法令组1例，阿司匹林组2例，差异无统计学意义（χ2 = 0.028，P = 0.867）；总血栓事件：华法令组2例，阿司匹林组2例，差异无统计学意义（χ2 = 0.026，P = 0.595）；全因死亡事件：华法令组2例，阿司匹林组3例，差异无统计学意义（χ2 = 0.011，P = 0.914）。结论 对于幼年和青年的无房颤并发症的Fontan手术病人，无论是华法令还是阿司匹林都可以取得近似的预防血栓的效果。故可以推荐病人使用抗血小板治疗，从而避免服用华法令频繁抽血监测INR的弊端，病人和家属的依从性也会更好。
- Abstract:
- ObjectiveTo compare the preventive effects of warfarin versus aspirin for thrombosis after total cavopulmonary anastomosis (Fontan).MethodsFrom February 2004 to December 2016,a total of 37 Fontan procedures were performed.The average age was (7.32±2.25) (3.5-12) years and the average age weight(23.58±4.25) (11.5-41) kg.Two groups were designated as warfarin group 0.06 mg·kg-1·d-1 (n=14) and aspirin group 5 mg·kg-1·d-1 (n=23).ResultsImmediate after operation 3 day chest and pericardium drainage:warfarin (17.33±5.62) vs aspirin (19.27±6.49) ml/kg,no statistical significance (t=0.305,P=0.633);blood transfusion:warfarin (15.18±4.73) vs aspirin (13.52±3.29) ml/kg,no statistical significance (t=0.718,P=0.452);within 3 years thrombotic events,warfarin (n=1) and aspirin (n=2),no statistical significance (χ2=0.028,P=0.867);total thrombotic events:warfarin(n=2) vs aspirin (n=2),no statistical significance (χ2=0.026,P=0.595);allcause mortality:warfarin (n=2) vs aspirin (n=3),no statistical significance (χ2=0.011,P=0.914).ConclusionFor juvenile and youth Fontan patients without atrial fibrillation,aspirin or warfarin shall obtain comparable effect of preventing thrombosis.Antiplatelet therapy is recommended.Avoiding frequent monitoring INR blood tests of warfarin,the compliance of patients and their families is better.
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