贵州医科大学学报

2020, v.45;No.239(08) 933-937

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依诺肝素联合华法林对中低危急性肺栓塞的疗效及预后的危险因素分析
The Effect of Enoxaparin Combined with Warfarin on the Prognosis of Patients with Moderate and Low Risk Acute Pulmonary Embolism

朱德才;秦锤雷;荣令;董慧芳;杜宣莉;马同亮;张传峰;李根;
ZHU Decai;QIN Chuilei;RONG Ling;DONG Huifang;DU Xuanli;MA Tongliang;ZHANG Chuanfeng;LI Gen;Department of Emergency Internal Medicine,Bozhou People's Hospital of Anhui Province;Department of Respiratory Medicine,Bozhou People's Hospital of Anhui Province;

摘要(Abstract):

目的:探讨依诺肝素联合华法林对中低危急性肺栓塞(APE)的治疗效果,并分析影响治疗后患者预后的危险因素。方法:98例中低危APE患者均给予依诺肝素联合华法林治疗,观察治疗3个月时的疗效;于治疗前及治疗3个月时,采用全自动血气分析仪记录动脉血氧分压(PaO_2)、动脉二氧化碳分压(Pa CO_2)、氧合指数(OI)水平,采用超声心动图记录心率、室间隔厚度(IVST)、左房内径(LAD)、主动脉内径(AOD)及左室射血分数(LVEF)的变化;根据随访12个月时预后将患者分成预后良好组及预后不良组,比较2组患者性别、年龄、发绀、胸痛、呼吸困难、下肢肿痛、合并症、右心室功能不全、恶性肿瘤、出现APE症状至诊断时间等指标,采用Logistic回归模型分析影响患者预后不良的危险因素。结果:98例患者中,治愈27例(27.55%),显效38例(38.78%),有效21例(21.43%),无效12例(12.24%),总有效率为87.76%;患者治疗后Pa O_2、OI明显高于治疗前,Pa CO_2明显低于治疗前(P <0.01);治疗后IVST、LAD、AOD低于治疗前,LVEF高于治疗前(P <0.05);随访12月时,82例(83.67%)患者预后良好、16例(16.33%)预后不良;预后不良组患者合并症、右心室功能不全、恶性肿瘤、出现APE症状至诊断时间≥48 h占比高于预后良好组(P <0.05); Logistic回归分析显示,中低危APE患者的合并症、右心室功能不全、恶性肿瘤、出现症状至诊断时间≥48 h是预后不良的危险因素(P <0.05)。结论:依诺肝素联合华法林对中低危APE的疗效较好,患者的合并症、右心室功能不全、恶性肿瘤、出现症状至诊断时间延长是影响治疗效果的危险因素。
Objective: To explore the effect of enoxaparin combined with warfarin on the prognosis of patients with moderate and low-risk acute pulmonary embolism( APE),and analyze the risk factors of poor prognosis. Methods: Ninety-eight patients with moderate and low-risk APE were included. All patients were treated with enoxaparin and warfarin for 3 months. Before the treatment and at 3 months after the treatment,we detected the levels of arterial blood oxygen partial pressure(PaO_2),arterial carbon dioxide partial pressure( PaCO_2) and oxygenation index( OI) using blood gas analyzer,measured heart rate,ventricular septal thickness( IVST),left atrial diameter( LAD),aortic diameter( AOD) and left ventricular ejection fraction( LVEF) using echocardiography. After 12 month followup,all patients were divided into good-and bad prognosis groups according to their prognosis status.The clinical characteristics of the two groups were compared. The risk factors of poor prognosis were analyzed by Logistic regression model. Results: Among the 98 patients,27 patients( 27. 55%) were cured,38 patients( 38. 78%) were obviously effective,21 patients( 21. 43%) were effective and 12 patients( 12. 24%) were ineffective. The total effective rate was 87. 76%. The treatment significantly increased PaO_2 and OI,but decreased PaCO_2( P < 0. 05). Moreover,the treatment greatly decreased IVST,LAD and AOD,but upregulated LVEF( P < 0. 05). For the prognosis,82 patients( 83. 67%)had a good prognosis,16 patients( 16. 33%) had a bad prognosis. The proportions of right ventricular dysfunction,malignant tumor,symptom to diagnosis time ≥ 48 h were significantly higher in the patients with poor prognosis than the patients with good prognosis( P < 0. 05). Logistic regression analysis showed that the complications,right ventricular dysfunction,malignant tumors and the time from symptoms to diagnosis≥48 h were the risk factors of poor prognosis( P < 0. 05). Conclusion:The efficacy of enoxaparin combined with warfarin for APE is ideal,but the complications,right ventricular dysfunction,malignant tumors as well as symptoms and delayed diagnosis time are risk factors for poor prognosis.

关键词(KeyWords): 华法林;依诺肝素;血气分析;危险因素;急性肺栓塞;预后不良
warfarin;enoxaparin;blood gas analysis;risk factors;acute pulmonary embolis(APE) m;poor prognosis

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金资助项目(81571528)

作者(Author): 朱德才;秦锤雷;荣令;董慧芳;杜宣莉;马同亮;张传峰;李根;
ZHU Decai;QIN Chuilei;RONG Ling;DONG Huifang;DU Xuanli;MA Tongliang;ZHANG Chuanfeng;LI Gen;Department of Emergency Internal Medicine,Bozhou People's Hospital of Anhui Province;Department of Respiratory Medicine,Bozhou People's Hospital of Anhui Province;

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DOI: 10.19367/j.cnki.2096-8388.2020.08.012

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