ObjectiveTo explore the anticoagulant strategy of adjusting the dose of warfarin at different stages after mechanical valve replacement of mitral valve.MethodsClinical data of a total of 302 patients, including 76 males and 226 females, with an average age of 50.1±10.1 years, who underwent mechanical mitral valve replacement in the Chinese adult cardiac surgery database from 2013 to 2017 were retrospectively analyzed. According to the dose adjustment strategy of taking warfarin, the patients were divided into a D group (adjusting warfarin dose in days) and a W group (adjusting warfarin dose in weeks) to evaluate the anti-coagulation effect of warfarin.ResultsThe total follow-up time was 423277 d (1159.7 years). There was no significant difference in the overall anticoagulant strength, and the warfarin dose adjusted in days was better in the early postoperative period (P<0.05), especially in patients over 60 years. It was better to adjust warfarin dose in weeks in the middle and long periods (P<0.05), especially in patients ≤40 years. In terms of the stability of anticoagulation, it was better to adjust the dosage of warfarin in weeks (P<0.05). It was better to adjust the dosage of warfarin in weeks for early, middle- and long-term anticoagulant therapy after operation (P<0.05), especially in the females aged >40 and ≤50 years.ConclusionWithin the target range of international normalized ratio (1.5-2.5), the anticoagulant strategy of adjusting warfarin dose in days after mechanical valve replacement of mitral valve can achieve a better anticoagulant strength, and adjusting the dosage of warfarin in weeks is better in the middle- and long-term after operation. In general, the anticoagulant effect is more stable in the short term when warfarin dose is adjusted on a weekly basis.
The First Affiliated Hospital of Zhengzhou University has explored the feasibility of day surgery based on the two-way referral system, that is, the patients underwent necessary preoperative preparations and examinations in the county hospital, contacted the referral hospital for referral-related matters, and made an appointment for surgery. After receiving day surgery at the First Affiliated Hospital of Zhengzhou University, the patients underwent short-term observation and treatment in the hospital. When the patients meet the discharge or transfer criteria, they will be discharged or transferred back to primary hospitals for rehabilitation treatment, and the day surgery center will continue to track and guide follow-up diagnosis and treatment. This article introduces the exploration and practice of day surgery for county hospitals in the First Affiliated Hospital of Zhengzhou University. This day surgery mode is highly maneuverable and is of great significance to promote the development of medical services in hospitals at all levels.