低分子肝素联合华法林单纯抗凝治疗急性次大面积肺栓塞的临床效果和安全性观察

摘要/Abstract

摘要： 目的分析低分子肝素联合华法林单纯抗凝治疗急性次大面积肺栓塞（Acute submassive pulmonary embolism,ASPE）的临床效果和安全性,探讨其应用价值。方法选取我院2011年5月~2016年6月收治的126例ASPE患者,按照随机数字表法分为观察组、对照组,各63例,观察组接受低分子肝素联合华法林单纯抗凝治疗,对照组接受低分子肝素、华法林抗凝联合尿激酶溶栓治疗,比较两组患者治疗前后各项临床指标变化,分析两种治疗方案的疗效与安全性。结果两组患者治疗后PaO₂、PaCO₂、RVEF均较治疗前升高,P（A-a）O₂、RVESVI、RVEDVI、PS、PC、D-D、t-PA、PAI-1、TM均较治疗前降低,差异有统计学意义（P<0.05）,治疗后动脉血气指标组间比较,差异无统计学意义（P>0.05）。观察组、对照组患者临床总有效率分别为92.06%、93.65%,组间比较差异无统计学意义（P>0.05）。观察组不良反应发生率为6.35%,低于对照组的26.98%,差异有统计学意义（P<0.05）。结论低分子肝素联合华法林单纯抗凝治疗ASPE可取得与联合溶栓治疗相近的疗效,且不良反应发生率更低,具有更好的安全性。

关键词: 低分子肝素, 华法林, 抗凝, 溶栓, 急性次大面积肺栓塞, 临床效果, 安全性

Abstract: Objective To analyze the clinical efficacy and safety of low molecular weight heparin combined with warfarin in anticoagulant treatment of acute submassive pulmonary embolism (ASPE), and investigate its application value.Methods 126 patients with ASPE from May 2011 to June 2016 in our hospital were involved in the study and randomly divided into two groups, including 63 patients who received the low molecular weight heparin combined with warfarin anticoagulant therapy as the observation group, while 63 cases who were treated with low molecular weight heparin and warfarin anticoagulant therapy combined with urokinase thrombolytic therapy as the control group. Changes of clinical indexes of patients before and after treatment were compared between the two groups, and the efficacy and safety of the two therapeutic strategies were analyzed. Results Compared with the levels before treatment, the PaO₂, PaCO₂, RVEF in both of the two groups increased, the P(A-a)O₂, RVESVI, RVEDVI, PS, PC, D-D, t-PA, PAI-1, TM decreased after treatment, the difference was statistically significant (P < 0.05). After treatment, there was no significant difference of the arterial blood gas indexes between the two groups (P > 0.05). The total effective rate of the observation group and the control group were 92.06% and 93.65% respectively, without statistical difference between the two groups (P > 0.05). The incidence of adverse reactions in the observation group was 6.35%, which was lower than that in the control group of 26.98%, the difference was statistically significant (P < 0.05). Conclusion Low molecular weight heparin combined with warfarin in anticoagulant treatment of patients with ASPE can obtain a similar effect as the strategy supplementary with thrombolytic therapy, and with lower incidence of adverse reactions and better safety.

Key words: low molecular weight heparin, warfarin, anticoagulation, thrombolysis, acute submassive pulmonary embolism, clinical efficacy, safety

中图分类号:

R973.2

陈丽秀. 低分子肝素联合华法林单纯抗凝治疗急性次大面积肺栓塞的临床效果和安全性观察[J]. 中国药物警戒, 2016, 13(11): 651-654.

CHEN Li-xiu. Clinical Efficacy and Safety of Low Molecular Weight Heparin Combined with Warfarin in Anticoagulant Treatment of Acute Submassive Pulmonary Embolism[J]. Chinese Journal of Pharmacovigilance, 2016, 13(11): 651-654.

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