创伤性肺栓塞患者应用华法林治疗前后血流动力学变化及意义

目的 探讨华法林对创伤性肺栓塞患者血流动力学的影响及临床意义.方法 从2011年5月至2013年5月收治的创伤性肺栓塞患者中随机选择50例进行研究,设为治疗组,实施华法林治疗.另择50例健康者作为正常对照组,观察记录两组的血流动力学变化情况.采用SPSS 15.0统计软件分析,计量资料采用t检验,并用（（x-）±s）表示,P＜0.05代表差异有统计学意义.结果 治疗前,治疗组的心率、体血管阻力、胸腔静水压、肺循环阻力（指标1）均显著高于正常对照组,差异均有统计学意义（P＜0.05）,平均动脉压、心脏指数、每搏输出量、每搏指数、肺动脉嵌压（指标2）均显著低于正常对照组（P＜0.05）.治疗后45 h,治疗组的指标2仍均低于正常对照组,只有90 h后治疗组的肺循环阻力与正常对照组差异无统计学意义（t=2.18,P＞0.05）.且治疗后各指标不同时间点与治疗前比较,差异均有统计学意义（均P＜0.05）.通过对患者国际标准化比值（INR）的监测,调整华法林实际用量,治疗过程中,比值始终保持在2.0 ～3.0,所有患者均未出现出血现象.结论 华法林会对创伤性肺栓塞患者血流动力学产生一定的影响,通过监测患者治疗过程中的血流动力学变化情况,可以更好的指导临床评估和治疗.

Regulation of hemodynamics of patients with posttraumatic pulmonary embolism by warfarin treatment and its clinical significance

Objective To explore therapeutic effect and clinical significance of Warfarin in treating patients with posttraumatic pulmonary embolism.Method From May 2011 to May 2013,50 patients with posttraumatic pulmonary embolism in our hospital were treated with Warfarin.Another 50 healthy persons served as a control group.The hemodynamic changes in the two groups were recorded and analyzed.Statistical analysis was performed by using SPSS 15.0 software.Measurement data were expressed by mean ± SD and received Student＇s t test.P ＜ 0.05 was considered statistically significant.Results Before Warfarin treatment,heart rate,body vascular resistance,pleural prcssure,pulmonary vascular resistance （index 1） in the treatment group were significantly higher than those in the control group,（P ＜ 0.05） ; whereas mean arterial pressure,cardiac index,stroke volume,stroke volume index,and pulmonary artery wedge pressure （index 2） were significantly lower than those in the control group（P ＜ 0.05）.Fourty-five hours after treatment,index 2 in the treatment group was still lower than that in the control group.After 90 hours only pulmonary vascular resistance in the treatment group and control group was not significantly different （t =2.18,P ＞ 0.05）.There was significant difference in index at different time points after treatment（P ＜0.05）.The international normalized ratio （INR） of the patients was monitored,by which actual amount of warfarin was adjusted.In the course of treatment,INR remained at 2.0-3.0,no bleeding was observed among all the patients.Conclusions Warfarin has a confirmed impact on hemodynamics in patients with posttraumatic pulmonary embolism.Mnitoring the hemodynamic changes of patients could guide the clinical evaluation and treatment of posttraumatic pulmonary embolism.