| Objective 1.After review of the case, and further the statistics in the region in 2003 -2009 after valve replacement, INR therapeutic range of warfarin dose and the incidence of anticoagulant-related complications.2. Statistics in the region after valve replacement, aortic valve, mitral valve, and double valve replacement patients after the approximate range of anticoagulation intensity and the amount of drug orally.3. Understanding of the target population of anticoagulant therapy known by relevant content. Raised in patients with mechanical heart valve replacement on anticoagulant therapy after the educational focus and content of anticoagulant therapy to improve patients understanding of awareness, improve the quality of anticoagulation therapy.4. Analysis Ningxia anticoagulation therapy after mechanical heart valve replacement with foreign and domestic coastal, southwest, north and other regions of the differences, make the necessary anticoagulation method.Methods The preset postoperative INR average control range in the 1.3-2.3 standards. Exclude cases in accordance with the principles of case selection. Check and record after 1 week, 2 weeks, 1 month, 3 months, 6 months, 12 months, 24 months, 36 months, 48 months, 60 months international normalized ratio (INR), Oral dose of warfarin (mg), the patients were combined with telephone follow-up. Summary of complications after mechanical valve replacement and treatment. Questionnaire according to the design table, on the basic situation of each patient, the content of anticoagulant therapy survey data obtained for classification, the use of SPSS 11.5and Office Excel statistical analysis software through the line.Data as mean±standard deviation ( x±s) that was used to compare between groups t test analysis to P <0.05 for the difference was statistically significant.(With mechanical heart valve replacement surgery-related complications, in strict accordance with American Thoracic Surgery in 1996 will develop the standards, details)Results 1.Artificial mechanical heart valve replacement in 264 patients, 237 patients completed follow-up, including out-patient review of 165 cases (62.50%), telephone follow-up 72 patients (27.27%), lost 27 cases (10.23%).Men and 126 cases (53.16%), female 111 cases (46.84%), the oldest 65 and the youngest 12 years old.MVR 110 cases (46.45%), AVR 76 cases (31.93%), DVR 51 cases (21.52%).194 cases of rheumatic disease (81.86%), degenerative disease in 34 patients (14.35%), infective endocarditic in 9 cases (3.79%). 2.Postoperative INR value 1.52±0.58, MVR INR value of 1.63±0.57 after surgery and postoperative INR DVR is 1.72±0.54, the overall postoperative INR value 1.63±0.56.Total oral dose of warfarin: 2.37mg±0.72mg / d. 3.Bleeding 11 cases, accounting for cases of general cases 4.64%. 3 cases under the skin, 5 cases scattered upon bleeder appear unexplained gum bleeds, 2 cases with nasal bleeding, 1 case appears black then, 2 cases died of bleeding in the brain. 5 cases of thrombosis accounted for 2.11% of total cases, 1 case of hemiplegia aphasia, hemiplegia in 2 cases, 2 cases of peripheral embolism. 4.Only 53 preoperative patients (22.36%) were aware that after mechanical heart valve replacement surgery on a regular basis, regular blood tests and patient follow-up.The 232 patients (97.89%) patients after valve replacement needs to know on a regular basis, regular blood tests and patient follow-up.Describes the clinical course of treatment, the doctor patient medical education for patients to understand disease, anticoagulant therapy plays a significant role to improve.But how to detect anticoagulant targets, how to adjust the anticoagulant dose, the patient awareness is very low.Conclusion 1.According to statistics, in 2009 the region was selected in 2003 artificial mechanical heart valve replacement patients were 237 cases of anticoagulant therapy intensity range: AVR group was INR value of 1.52±0.58, MVR group were INR value of 1.63±0.57 and DVR group Postoperative INR value 1.72±0.54Selected patients with total oral dose of warfarin: 2.37mg±0.72mg / d. And recommends AVR group was testing the range of INR 1.3-2.0, MVR and DVR design detection range of 1.3-2.3. 2.The general population related content on the awareness of anticoagulant therapy is not high. Patients should be strengthened before and after anticoagulant therapy education, improve the patient's own treatment of the awareness of anticoagulant therapy, to enhance the communication between the patient and follow-up conditions, the establishment of anticoagulant therapy in patients with individual databases, for the future Better conditions for rational therapy. 3.The area of anticoagulation after mechanical heart valve replacement therapy and the detection range for different INR oral dose of warfarin, to reduce postoperative complications, increased patient's recovery is significant. |
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