冠脉支架术后患者行髋关节置换术的围手术期抗凝治疗体会

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1、麵链术后患截融糊酔糊施台疗2018-03-2712:00:30中国现代医生2018年3期向亮贺洪辉张卫［摘耍］鬥的探讨冠脉支架祖入术后患者行髋关节置换术的围乎术期抗凝治疗策略。方法回顾性分析我科2010年1月〜2017年1月收治的15例冠脉支架术后行髋关节置换患者的临床资料，观察住院期间心绞痛、心肌梗死、缺iflL性室性恶性心律失常发生情况及出血、血栓的发生情况，总结该类患者网手术期的抗凝治疗方案。结果15例患者的术屮出血fi为230〜520mL,平均(347±81)mL；术后引流量为350〜680mL，平均(460±75)mL。术后无一•例出现重度出血以及无一例因大量出血而导致计划外输血或

2、需手术止血等出血事件，1例出现术后拔除伤门引流管后引流管门处持续渗血，伤口处予局部加压包扎，5d后滲血消失。无一例出现下肢深静脉血栓及瓣膜血栓及发生心绞痛、心肌梗死、缺血性室性恶性心律失常等。结论冠脉支架术后髋关W置换患荇围手术期合理选择抗凝方案，可以降低岡手术期心脏車件的发生率，并且不增加血栓及出血的风险。［关键词］关节置挽；冠脉支架；围手术期；抗凝［中图分类号］R687.3［文献标识码］B［文章编号］1673-9701(2018)03-0060-03Theexperienceofperioperativeanticoagulationtherapyinpatientsundergoing

3、hiparthroplastyaftercoronarystentingXIANGLiangHEHonghuiZHANGWeiDepartmentofJointandSportsMedicine,AffiliatedNanhuaHospital,UniversityofSouthChina，Hengyang421002,China［Abstract］ObjectiveToinvestigatetheperioperativeanticoagulationstrategiesforpatientsundergoinghiparthroplastyaftercoronarystenting.Me

4、thodsTheclinicaldataof15patientsundergoingtotalhiparthroplastywhounderwentcoronarystentingfromJanuary2010toJanuary2017inourdepartmentwereretrospectivelyanalyzed.Situationofanginapectoris,myocardialinfarction,ischemicventriculararrhythmia,bleedingandthrombuswereobservedduringhospitalization.Theperio

5、perativeanticoagulanttreatmentofsuchpatientsweresummarized.ResultsIntraoperativebloodlossvolumeof15caseswas230-520mL,anaverageof(347±81)mL；postoperativedrainagevolumewas350-680mL,anaverageof(460±75)mL.Noneofthepatientshadseverebleedingafteroperation,andnocaseofunplannedbloodtransfusioncausedbymassi

6、vebleedingorbleedingcallingforsurgicalhemostasis.Onepatienthadsustainedbleedingatthenozzleofdrainagetubeafterremovingthedrainagetube.Localwounddressingwasappliedandthebleedingdisappearedafter5days.Nocaseofdeepvenousthrombosisandvalvularthrombosis,anginapectoris,myocardialinfarction,ischemicventricu

7、lararrhythmia,etc.ConclusionRationalchoiceoftreatmentforperioperativeanticoagulationinpatientsundergoingtotalhiparthroplastycanreducetheincidenceofperioperativecardiaceventswithoutincreasingtheriskofthrombo