機械的な心弁血栓症. 機械的な心弁血栓症. フィブリノリシスは正当化されるのか?
R Roudaut1, T Labbe, M F Lorient-Roudaut
1Cardiologic Hospital of Bordeaux, France.
Circulation
|November 1, 1992
まとめ
フィブリノリチック療法では,人工心臓弁の血栓形成の非手術的選択肢が提供されていますが,脳栓塞などのリスクがあります. その使用は,特に重症患者の場合,慎重に検討する必要があります.
科学分野:
- 心臓病学 心臓病学
- 血管医学 血管医学とは
- 薬理学 薬理学とは
背景:
- 義手心弁の血栓形成は,弁置換手術の重大な合併症である.
- この状態の管理は困難である可能性があります.
- 血栓解消薬療法は,潜在的な治療戦略として浮上しています.
研究 の 目的:
- 假心弁の血栓形成の治療におけるフィブリノリート剤の有効性と安全性を評価する.
- 異なるバルブタイプと患者の状態におけるフィブリノリチックの治療の結果を比較する.
主な方法:
- 義肢心弁血栓症の75例を患った64人の患者を対象とした研究.
- 繊維分解剤を用いた治療: ストリープトキナーゼ,ウロキナーゼ,または再結合組織型プラズミノゲン活性化剤.
- 治療の成功,合併症,患者のアウトカムに関するデータを収集します.
主要な成果:
- フィブリノリチックの治療は73%の症例で完全な成功を達成し,大動脈義肢 (85%) がミトラル義肢 (63%) に比べてよりよい結果を示しました.
- 患者の14.6%が治療中に脳栓塞を経験し,4人の脳栓塞が致死しました.
- 9人の患者が死亡し,18人の患者は最終的に緊急手術を必要とした.
結論:
- フィブリノリチック療法 (fibrinolytic therapy) は,人工心臓弁の血栓症,特に三弁の症例や重症患者の治療に有効な非外科的な代替手段である.
- 脳栓塞のリスクは,慎重に患者の選択を必要とする.
- 線維解毒剤によるパラバルブラー血栓症の管理については,さらなる研究が必要である.
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