利伐沙班治疗脑卒中后急性肺栓塞的疗效观察

目的观察利伐沙班治疗脑卒中后高出血风险急性肺栓塞的疗效。方法选取脑卒中后高出血风险急性肺栓塞患者62例,随机分成2组。对照组31例给予低分子量肝素钠皮下注射和口服华法林序贯治疗,根据INR调整剂量;治疗组31例给予低分子量肝素钠皮下注射,口服利伐沙班10mg,1次/d。比较2组治疗前和治疗1、3、6个月后的血气分析、血氧饱和度(SaO_2)、呼吸困难VAS评分、圣乔治呼吸问卷评分和超声心动图检查,比较2组不良事件发生率。结果与治疗前比较,2组治疗后PaO_2、PaCO_2、SaO_2、RVEF水平均有所升高,呼吸困难VAS评分、圣乔治呼吸问卷评分、PASP、MPAP、RAP和PVR水平均有所降低,差异均有统计学意义(P0.05)。与对照组比较,治疗组治疗后3、6个月PaO_2、PaCO_2、SaO_2、RVEF水平较高,呼吸困难VAS评分、圣乔治呼吸问卷评分、PASP、MPAP、RAP、PVR水平较低,差异均有统计学意义(P0.05);2组不良事件发生率比较,差异无统计学意义(P0.05)。结论采用利伐沙班治疗脑卒中后高出血风险急性肺栓塞疗效满意,出血风险与常规抗凝相当。

Therapeutic effect of rivaroxaban on acute pulmonary embolism in ischemic stroke patients

Objective To investigate the effectiveness of rivaroxaban on acute pulmonary embolism in ischemic stroke patients with high risk of hemorrhage.Methods In a randomized controlled trial,sixty-two ischemic stroke patients with acute pulmonary embolism and high risk of hemorrhage were randomly assigned into two groups:study group and control group.Control group (31 cases) received subcutaneous injection of low molecular weight heparin (LMWH) once 12 hours,of which the dosage was adjusted with weight,one to three days later subsequently followed with warfarin,which the dosage was adjusted with INR,while the study group (31 cases) received oral rivaroxaban 10 mg once daily.Changes of PaO2,PaCO2,SaO2,visual analogue scale (VAS) for dyspnea,the St.George's respiratory questionnaire score(SGRQ),and echocardiography parameters before and 1,3,6 months after treatment were observed in both groups.The incidence of bleeding event or adverse event was compared between the two groups.Results Three and six months after the treatment,patients in both groups had a increased level of PaO2,PaCO2,SaO2,and right ventricular ejection fraction (RVEF);and a decreased level of VAS for dyspnea,SGRQ score,pulmonary artery systolic pressure(PASP),mean pulmonary artery pressure(MPAP),right atrial pressure (RAP),right ventricular pressure (RVP)(P＜0.05).When compared with the control group,PaO2,PaCO2,SaO2,and RVEF levels were significantly higher,and VAS for dyspnea,SGRQ score,PASP,MPAP,RAP,PVR were significantly lower in the study group (P＜0.05).The incidence of bleeding event or adverse event of the 2 groups was similar (P＞0.05).Conclusion Oral rivaroxaban therapy was effective for ischemic stroke patients with acute pulmonary embolism and high risk of hemorrhage after stroke.The risk of bleeding was similar to the conventional injection with LMWH.