华法林联合低分子肝素治疗产后静脉血栓栓塞症的疗效观察

目的探讨华法林钠片联合低分子量肝素钠注射液治疗产后静脉血栓栓塞症的临床疗效。方法选取2010年7月—2015年7月在承德医学院附属医院进行诊治的产后静脉血栓栓塞患者67例为研究对象,所有入选产妇根据治疗差异分为对照组(34例)和治疗组(33例)。对照组产后12 h皮下注射低分子量肝素钠注射液,100 IU/kg,2次/d。治疗组在对照组的基础上口服华法林钠片,首次2.5 mg,1次/d,根据其结果调整华法林用量,当凝血酶原时间的国际标准化比值为2.0~3.0时,停用低分子量肝素钠注射液。两组患者均连续治疗3个月。观察两组的临床疗效,比较两组的血管通畅情况和不良事件。结果治疗后,对照组和治疗组的总有效率分别为73.53%、90.91%,两组比较差异有统计学意义(P0.05)。治疗后,对照组和治疗组的血管通畅率分别为73.53%、84.85%,两组比较差异有统计学意义(P0.05)。对照组和治疗组的血栓形成后综合征发生率分别为35.29%、12.12%,两组比较差异有统计学意义(P0.05)。结论华法林钠片联合低分子量肝素钠注射液治疗产后静脉血栓栓塞症具有较好的临床疗效,可增加血管通畅率,安全较好,具有一定的临床推广应用价值。     

法舒地尔联合低分子肝素钙治疗肺血栓栓塞症的临床观察

目的 观察法舒地尔联合低分子肝素治疗肺血栓栓塞症的临床疗效.方法 将46例非大面积肺血栓栓塞症患者完全随机分为2组,法舒地尔联合低分子肝素组和普通肝素组各23例.法舒地尔联合低分子肝素组给予低分子肝素钙1 mg/kg皮下注射,1次/12 h,第8天起加用华法林,第11天停用低分子肝素,总疗程3～6个月;同时应用盐酸法舒地尔30 mg+生理盐水100ml静脉滴注,1次/8 h,连续应用14 d.普通肝素组给予普通肝素首剂80 IU/kg静脉注射,然后以18 IU/(kg·h)的剂量静脉泵入,第8天起加用华法林,第11天停用普通肝素.在抗凝过程中,分别观察2组患者血小板、出凝血时间、国际标准化比值(INR)、APTT、D-二聚体、纤维蛋白原、血气分析( ABG)、肺核素通气/灌注扫描(V/Q)、CT肺动脉造影( CTPA)等情况,对2组治疗前和治疗后30 d的结果进行疗效评价.结果 法舒地尔联合低分子肝素组治愈14例,显效7例,好转2例,无无效和恶化患者,总有效率100.0％.普通肝素组治愈9例,显效3例,好转5例,无效5例,恶化1例,总有效率73.9％.2组总有效率差异有统计学意义(P＜0.05).2组均未出现严重出血.结论 法舒地尔联合低分子肝素治疗非大面积肺血栓栓塞症是一种安全、有效的方法.     

低分子肝素钙治疗恶性肿瘤合并血栓栓塞症60例疗效分析

目的:探讨低分子肝素钙(速碧林)治疗恶性肿瘤合并静脉血栓栓塞症(venous thromboembo-lism,VTE)的疗效及安全性。方法:回顾性分析2007年8月-2011年7月发生静脉血栓栓塞症的60例恶性肿瘤患者应用速碧林治疗后的转归情况。采用χ2检验分析疗效与各临床因素的相关性及二次血栓发生与各临床因素的相关性;Kaplan-Meier及COX回归分析临床因素与预后的关系。结果:经过皮下注射速碧林治疗,36例(60%)患者的血栓完全缓解(CR);21例(35%)部分缓解(PR);3例(5%)病情稳定(SD)。治疗过程中无严重并发症出现,速碧林的疗效与患者性别、年龄、肿瘤类型、分期、是否吸烟、是否静脉置管、风险评分、治疗时间的长短、血栓时症状的多少、化疗药物的种类、是否合并使用抗血管生成药物、血小板和D-二聚体计数等因素无明显相关性。血小板异常患者二次血栓的发生率明显高于血小板计数正常患者(33.3%vs 2.0%,P=0.009)。单因素分析提示分期早(I,II期)、治疗时间大于30 d和风险评分高(5分以上)的患者预后较好,但多因素分析表明只有分期和风险评分是独立的预后因素。结论:速碧林治疗恶性肿瘤合并血栓栓塞症安全有效,分期早和高风险的患者更能从抗凝治疗中受益。     

低分子肝素联合参芎注射液治疗肿瘤静脉血栓栓塞分析

目的观察低分子肝素联合参芎注射液治疗肿瘤静脉血栓栓塞的临床疗效。方法选取2010-2011年我院收治的恶性肿瘤患者共24例,随机分为治疗组和对照组,每组12例。对照组仅予低分子肝素(速碧林)治疗,85 IU/kg皮下注射,治疗组在对照组的基础上给予参芎注射液200 mL静滴。两组患者的疗程均为15d。结果治疗组总有效率(100%)明显高于对照组(83.3%),两组比较差异有统计学意义(P<0.05)。两组患者在用药期间均未发生出血倾向及过敏反应。结论低分子肝素联合参芎注射液治疗肿瘤静脉血栓栓塞,效果显著,未见明显的不良反应。     

低分子肝素预防脑出血后静脉血栓的安全性研究

目的探讨脑出血患者抗凝预防静脉血栓栓塞时颅内血肿体积变化及相关安全性。方法回顾性分析脑出血或脑出血合并脑室出血的患者,均在入院7 d内予以注射低分子肝素,并在用药7 d后复查头颅CT。计算患者低分子肝素治疗前后CT上的颅内血肿体积的变化,血肿体积的计算使用ABC/2法,脑室出血量的计算使用手绘出血区域方法。结果共入选64例,平均年龄65岁,美国国立卫生研究院卒中量表（NIHSS）评分中位值为10.6,基线时血肿体积平均为（24.3±22.3）ml,低分子肝素治疗前后CT检查上的颅内血肿体积变化为（-4.35±10.5）ml,仅有1例的血肿体积增大。经分析,自发性脑出血患者发病7 d内给予低分子肝素预防深静脉血栓并不导致颅内血肿的增大。结论在脑出血伴/不伴脑室出血的急性期,给予皮下注射低分子肝素预防静脉血栓栓塞不导致颅内血肿的增大。     

急性肺血栓栓塞症药物治疗的临床观察

目的观察急性肺血栓栓塞症抗凝与溶栓前后的症状、血气指标、心电图、超声心动图、肺通气/灌注扫描的变化。方法选用2000年1月～2006年7月年我院就诊的急性肺动脉栓塞患者35例。既往均无心肺疾患。行超声和肺通气/灌注扫描后随机分为两组,15例进行了溶栓治疗,20例行低分子肝素抗凝。观察溶栓和抗凝前后症状、动脉血气分析、心电图、超声心动图。结果症状、血气指标、超声心动图、肺通气/灌注扫描,溶栓组比抗凝组改善明显,P<0.05。结论溶栓比单纯抗凝效果好。     

阿托伐他汀联合低分子肝素治疗肾病综合征的疗效观察

目的 探讨阿托伐他汀联合低分子肝素治疗肾病综合征的疗效.方法 选择本院2014年1月至2015年12月收治的200例肾病综合征患者,按照治疗方法的不同分为观察组和对照组,各100例.对照组在常规治疗基础上给予低分子肝素,观察组在对照组治疗基础上给予阿托伐他汀,观察两组治疗效果及患者血脂、肾功能各指标的改善情况.结果 两组血清白蛋白(Alb)、24 h尿蛋白定量(Pr)、血尿素氮(BUN)指标均明显改善,与治疗前比较,均P＜0.05;治疗后,观察组Alb、Pr、BUN指标分别为(26.97±3.65)g/L、(1.97±0.81)mmol/L、(6.41±2.29)mmol/L,与对照组的(23.76±3.31)g/L、(2.72±1.92)mmol/L、(7.17±2.88)mmol/L比较更趋于正常,效果优于对照组,均P＜0.05;两组血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)均明显改善,与治疗前比较,均P＜ 0.05,治疗后,观察组TC、TG、HDL-C、LDL-C指标分别为(3.67±0.99)mmol/L、(1.25±0.77)mmol/L、(3.96±1.33) mmol/L、(3.15±1.36) mmol/L,对照组分别为(6.12±1.25) mmol/L、(2.17±1.67)mmol/L、(3.31-1.25) mmol/L、(5.33±2.91) mmol/L,观察组更趋于正常,效果优于对照组,均P＜0.05;观察组和对照组的总有效率分别为87.0％和68.0％,组间比较,P＜0.05.两组均未见明显不良反应.结论 阿托伐他汀联合低分子肝素治疗肾病综合征能有效改善患者血脂、肾功能指标,疗效确切.     

Safety of low molecular weight heparins in the treatment of venous thromboembolism

Low molecular weight heparins (LMWHs) are commonly employed as a substitute for unfractionated heparin (UFH) in the treatment of venous thromboembolic events. Despite their higher cost, the preferential use of LMWHs seemed justified initially as, based on the results of earlier meta-analyses, these compounds were deemed to be more effective and safer than UFH. Although, in this respect, their purported superiority over UFH could not be confirmed by subsequent large, randomised trials and updated meta-analyses, other peculiar features of LMWHs were highlighted, favouring their preferential utilisation in patients with venous thromboembolism. Among these, the possibility of once-daily administration on an out-patient basis, the lower incidence of Type II heparin-induced thrombocytopenia and the lower likelihood of osteoporosis after prolonged treatment periods, appear to be especially prominent. This review attempts to evaluate the available evidence focusing on the safety of LMWHs for the treatment of venous thromboembolism and the current therapeutic options and potential advantages of LMWHs, either in general or in selected patient populations.     

银杏注射液联用低分子肝素治疗脑梗死临床观察

目的观察银杏注射液联用低分子肝素治疗脑梗死的临床疗效方法选择96例住院脑梗死患者随机分为银杏注射液联用低分子肝素治疗组（设为治疗组,51例）,单用低分子肝素治疗组（设为对照组,45例）,对治疗效果进行观察。结果治疗组总有效率90.2%,对照组有效率73.3%,两组疗效比较差异显著（P〈0.05）。结论银杏注射液联用低分子肝素治疗脑梗死有良好的疗效。     

Safety of low molecular weight heparins in the treatment of venous thromboembolism

Low molecular weight heparins (LMWHs) are commonly employed as a substitute for unfractionated heparin (UFH) in the treatment of venous thromboembolic events. Despite their higher cost, the preferential use of LMWHs seemed justified initially as, based on the results of earlier meta-analyses, these compounds were deemed to be more effective and safer than UFH. Although, in this respect, their purported superiority over UFH could not be confirmed by subsequent large, randomised trials and updated meta-analyses, other peculiar features of LMWHs were highlighted, favouring their preferential utilisation in patients with venous thromboembolism. Among these, the possibility of once-daily administration on an out-patient basis, the lower incidence of Type II heparin-induced thrombocytopenia and the lower likelihood of osteoporosis after prolonged treatment periods, appear to be especially prominent. This review attempts to evaluate the available evidence focusing on the safety of LMWHs for the treatment of venous thromboembolism and the current therapeutic options and potential advantages of LMWHs, either in general or in selected patient populations.     

Dose adjusted heparin treatment of deep venous thrombosis: a comparison of unfractionated and low molecular weight heparin

Summary Two studies have been done to establish recommendations for dosage and dose adjustment in the treatment of deep vein thrombosis (DVT) with low molecular weight heparin (LMWH). In the first, 56 patients were randomized in a double blind study to be treated either with unfractionated heparin (UFH) or LMWH s. c. every 12 h. Initial doses were given according to age and sex, disregarding bodyweight, and the dose was then adjusted when the peak plasma heparin concentration fell outside the desired range of 0.5–0.8 anti-FXa U/ml.There were fewer dose adjustments in the LMWH group. The correlation between injected dose (U/kg bodyweight) and the heparin concentration was higher in the LMWH group (r=0.59) than in the UFH group (r=0.38). The results suggest that, in order to obtain the desired heparin concentration, the initial dose of LMWH should be about 100 U/kg bodyweight every 12 h.In the second, open study, this dosage plan was followed in 15 patients. The peak heparin concentration on Day 2 ranged from 0.40 to 0.75 anti-FXa U/ml and adjustment was only required in 3 patients. Day to day variation in peak heparin activity in the individual patient varied little (CV 11–22%), and there was no accumulation.The results indicate that plasma heparin concentration is more predictable using LMWH than UFH, and they point to definite advantages in the use of LMWH in a bodyweight adjusted dosage.     

低分子肝素治疗急性脑梗死的临床研究

目的 观察低分子肝素（LMWH）治疗急性脑梗死的疗效及安全性。方法 将106例起病在48小时内的急性脑梗死患者随机分为治疗组和对照组,分别给予低分子肝素及普通治疗。结果 治疗组较对照组神经功能明显提高（P＜0．01）,治疗期间无不良反应及并发症。结论 低分子肝素治疗急性脑梗死是安全有效的。     

低分子肝素的临床应用

低分子肝素是通过酶解或化学降解的方法得到分子量较小的普通肝素片断,较普通肝素抗凝血作用小,出血等不良反应发生率低,是一类很有价值的抗凝药物。本文详细介绍低分子肝素的药理作用,对其在不稳定型心绞痛、深静脉血栓、进展型脑梗死、介入治疗及抗炎作用的临床应用进行综述,同时就临床常用的低分子肝素之间化学结构及抗Xa/IIa比值等细微差别进行比较。     

相对低分子质量肝素对大鼠的抗凝血作用

目的：观察相对低分子质量肝素（LMWH）的抗凝作用。方法：大鼠予LMWH,sc后,采血进行体外循环试验且取血浆测定凝血指标。结果：2或4mg/kg的LMWH能显著延长纤维蛋白栓形成时间（TFT）,显著减少血栓的干湿重量。1mg/kgLMWH仅能延长TFT和减少血栓长度。对常用凝血指标如全血凝血时间（CT）、复钙时间（RT）、凝血酶原时间（PT）和凝血酶时间（TT）也有显著的延长作用,但对白陶土部分凝血活酶时间（KPTT）作用较弱。普通肝素4mg/kg对以上各指标也有极显著的作用。结论：LMWH能抑制血栓形成,同时有导致出血的倾向。     

Nasal administration of low molecular weight heparin

The main objective of this study was to determine if the systemic absorption of therapeutic amounts of heparin was possible following nasal administration. Sprague-Dawley rats received nosedrops containing a low molecular weight heparin (LMWH) or unfractionated heparin (UFH) formulated with or without tetradecylmaltoside (TDM). TDM is a nonionic surfactant that has been previously shown to be a potent absorption enhancer in studies with peptide drugs. LMWH/UFH absorption was determined by measuring plasma anti-Factor Xa activity. The inclusion of 0.25% TDM in nasal formulations containing LMWH resulted in a significant increase in the C(max) and area under the curve (AUC) of anti-Factor Xa activity when compared to LMWH formulated in saline alone. The addition of TDM to a nasal formulation containing UFH resulted in a much smaller increase in the C(max) and the AUC of anti-Factor Xa activity. The absolute bioavailability of LMWH was increased from 4.0 +/- 0.4% in the absence of TDM to 19 +/- 0.3% in the presence of TDM. The reversibility of the absorption enhancing effect of TDM was studied by applying LMWH nasally 60 or 120 min after the enhancer. The effect of TDM on the nasal epithelia appeared to be rapidly reversible. In conclusion, nasal delivery of LMWH, but not UFH, was successful when an absorption enhancer was included to increase nasal permeability.     

低分子量肝素的研究进展

低分子量肝素是一种新型抗凝药,具有抗凝血、抗血栓、抗肿瘤等作用,与普通肝素相比具有皮下注射吸收好、半衰期长、生物利用率高等优点。本文介绍了低分子量肝素的化学结构、作用机制及其应用,并对低分子量肝素的制备方法进行了综述。     

低分子肝素治疗肾病综合征临床疗效观察

目的 观察低分子肝素（LMWH）对原发性肾病综合征的疗效和安全性。方法 30例原发性肾病综合征病人随机分为两组，对照组给予强的松。LMWH组在强的松治疗的基础上每日加用LMWH皮下注射。结果 LMWH组血纤维蛋白原（FIB），D－二聚体浓度明显下降，24h尿蛋白明显下降，血浆白蛋白明显上升。结论 LMWH可以明显改善原发性肾病综合征的高凝状态，延缓肾功能。     

低分子肝素治疗不稳定型心绞痛

目的：探讨低分子肝素（LMWH）对不稳定型心绞痛（UAP）的疗效。方法：入选111例UAP患者，随机分成LMWH组和普通肝素组（UFH）。LMWH组皮下注射LMWH2500U，2次／d，连续5日，1次／d,2－3日；UFH组皮下注射UFH7500U，2次／d，连续5日，1次／d，2－3日。观察心绞痛发作次数、心电图变化、副作用及实验室指标。 结果：LMWH组与UFH组同样有效控制UAP患者的临床症状，显著降低纤维蛋白原水平；LMWH组有效缓解症状的时间较UFH组短、副作用少，有显著生差异（P＜0．01）。结论：应用LMWH治疗UAP有效、安全、方便。