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
郑 佳1,李仲智1,李晓峰1,刘 晖1,柏 松1,郭 健1,丁 楠1,李 青2,伊寒露1

1.首都医科大学附属北京儿童医院心脏中心( 北京市, 10045); 2.山西省儿童医院心脏外科(山西省太原市, 030015),Email:Lwc20002@126.com

全腔静脉肺动脉吻合术; 血栓形成; 阿司匹林; 华法令

Prevention of thrombosis after total cavopulmonary anastomosis:a single-center study.
Zheng Jia1,Li Zhongzhi1,Li Xiaofeng1,Liu Hui1,Bai Song1,Guo Jian1,Ding Nan1,Li Qing2,Yi Hanlu1.

1.Department of Cardiac Center,Affiliated Beijing Children's Hospital,Capital Medical University,Beijing,100045,China; 2.Department of Cardiac Surgery,Shanxi Children's Hospital,Taiyuan 030015,China

Total cavopulmonary anastomosis; Thrombosis; Aspirin; Warfarin

DOI: 10.3969/j.issn.1671— 6353.2018.05.005

备注

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。
Objective To compare the preventive effects of warfarin versus aspirin for thrombosis after total cavopulmonary anastomosis(Fontan). Methods From 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). Results Immediate 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); all-cause mortality:warfarin(n=2)vs aspirin(n=3),no statistical significance(χ2=0.011,P=0.914). Conclusion For 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.