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低分子肝素钙和利伐沙班联合阿托伐他汀对急性肺栓塞患者相关指标的影响
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| 篇名： | 低分子肝素钙和利伐沙班联合阿托伐他汀对急性肺栓塞患者相关指标的影响 |
| TITLE： | |
| 摘要： | 目的：探讨低分子肝素钙和利伐沙班联合阿托伐他汀对急性肺栓塞患者相关指标的影响。方法：回顾性分析72例急性肺栓塞患者资料，根据治疗方案的不同分为A组（21例）、B组（26例）和C组（25例）。A组患者入院后立即肌内注射低分子肝素钙注射液2 d后加用华法林钠片，7 d后停用低分子肝素钙注射液，继续服用华法林3～6个月。B组患者给予低分子肝素钙注射液（用法用量同A组），2 d后加用利伐沙班片7 d后停用低分子肝素钙注射液，继续服用利伐沙班3～6个月。C组患者在B组治疗的基础上给予阿托伐他汀钙片，持续3～6个月。观察3组患者呼吸困难、胸痛、发绀消失时间，治疗前后心率（HR）、动脉血氧分压[pa（O2）]、动脉血二氧化碳分压[pa（CO2）]、C反应蛋白（CRP）、D-二聚体（D-D）、肿瘤坏死因子α（TNF-α）、白细胞介素1（IL-1）、IL-6、内皮素1（ET-1）、一氧化氮（NO）水平，临床终点事件发生情况和不良反应发生情况。结果：患者呼吸困难、胸痛、发绀消失时间A组＞B组＞C组，差异均有统计学意义（P＜0.05）。治疗前，3组患者HR、pa（O2）、pa（CO2）、CRP、IL-1、IL-6、TNF-α、D-D、ET-1、NO水平比较，差异均无统计学意义（P＞0.05）。治疗后，3组患者HR均显著低于同组治疗前，且A组＜B组＜C组；3组患者pa（O2）、pa（CO2）均显著高于同组治疗前，且A组＞B组＞C组，组间比较差异均有统计学意义（P＜0.05）。治疗后，3组患者CRP、IL-1、IL-6、TNF-α、D-D水平均显著低于同组治疗前，且C组＜A、B组，差异均有统计学意义（P＜0.05）；但A、B组比较，差异均无统计学意义（P＞0.05）。治疗后，3组患者ET-1水平均显著低于同组治疗前，且C组＜B组＜A组；3组患者NO水平均显著高于同组治疗前，且C组＞B组＞A组，差异均有统计学意义（P＜0.05）。C组患者临床终点事件发生率显著低于A组，B组患者不良反应发生率显著低于A组，差异均有统计学意义（P＜0.05）。结论 ：低分子肝素钙和利伐沙班联合阿托伐他汀可显著改善急性肺栓塞患者的临床症状、血气指标，减轻血管内皮受损程度，降低细胞因子水平，改善预后，且未增加不良反应的发生。 |
| ABSTRACT： | OBJECTIVE： To investigate the effects of low molecular weight heparin calcium and rivaroxaban combined with atorvastatin on related indexes in patients with acute pulmonary embolism （APE）. METHODS： The data of 72 APE patients were analyzed retrospectively. According to treatment plan， the patients were divided into group A （21 cases）， group B （26 cases） and group C （25 cases）. Group A was treated with intramuscular injection of Low molecular heparin calcium injection immediately after admission； 2 days later， they were given Warfarin sodium tablets； 7 days later， Low molecular heparin calcium injection was stopped while warfarin was still administrated， lasting for 3-6 months. Group B was given Low molecular heparin injection（same usage and dose as group A）； 2 days later， they were additionally treated with Rivaroxaban tablets； 7 days later， Low molecular heparin calcium injection was stopped while rivaroxaban was still administrated， lasting for 3-6 months. Based on the treatment in group B， group C was treated with Atorvastatin calcium tablets 20 mg orally， once a day in the evening， lasting for 3-6 months. The time of dyspnea，chest pain and cyanosis disappearance were observed in 3 groups as well as the levels of HR，pa（O2），pa（CO2）， CRP， D-dimer， TNF-α， IL-1， IL-6， ET-1 and NO before and after treatment. The occurrence of clinical outcome events and ADR were also observed. RESULTS： The time of dyspnea， chest pain and cyanosis disappearance in group A were longer than group B， and the group B was longer than the group A， with statistical significance （P＜0.05）. Before treatment， there was no statistical significance in the levels of HR， pa（O2），pa（CO2）， CRP， IL-1， IL-6， TNF-α， D-D， ET-1 and NO among 3 groups （P＞0.05）. After treatment， HR of 3 groups were all lower than before， and they showed group A＜group B＜group C； the levels of pa（O2） and pa（CO2） in 3 groups were all significantly higher than before， and they showed group A＞group B＞group C， with statistical significance （P＜0.05）. After treatment， CRP， IL-1， IL-6， TNF-α and D-D levels in 3 groups were significantly lower than before， and they showed group C＞group A and group B， with statistical significance （P＜0.05）；but there was no statistical significance between group A and B （P＞0.05）. ET-1 levels in 3 groups were significantly lower than before， and the levels showed group group C＜group B＜group A； NO levels of 3 groups were significantly higher than before， and the levels showed group C＞group B＞group A，with statistical significance （P＜0.05）. The incidence of clinical outcome events in group A was significantly higher than group C， the incidence of ADR in group B was significantly lower than that group A， with statistical significance （P＜0.05）. CONCLUSIONS： Low molecular weight heparin calcium and rivaroxaban combined with atorvastatin can significantly improve clinical symptoms and blood gas indexes， relieve vascular endothelial damage， reduce the levels of inflammatory cytokines and improve the prognosis of patients with APE， without increasing the incidence of ADR. |
| 期刊： | 2017年第28卷第21期 |
| 作者： | 许坤，赵弘卿，冯金萍，朱湘芸，韩曙光，王洵 |
| AUTHORS： | XU Kun，ZHAO Hongqing，FENG Jinping，ZHU Xiangyun，HAN Shuguang，WANG Xun |
| 关键字： | 急性肺栓塞；低分子肝素钙；利伐沙班；阿托伐他汀；安全性 |
| KEYWORDS： | Acute pulmonary embolism； Low molecular weight heparin calcium； Rivaroxaban； Atorvastatin； Safety |
| 阅读数： | 496 次 |
| 本月下载数： | 7 次 |
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