慢性心衰抗凝干预对心电图、凝血功能的影响

目的研究慢性心衰(CHF)抗凝干预对心电图、凝血功能的影响,记录1年随访观察结果。方法选取我院2012年4月至2014年10月心内科收治的76例CHF患者,随机分为2组。其中对照组38例按照CHF治疗指南给予抗心衰常规治疗,主要包括利尿剂、血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂等,观察组38例在对照组基础上口服抗凝药物华法林维持治疗。分别于治疗3个月后、治疗6个月后动态观察如下指标:1两组临床疗效;2超声心电图心功能指标左心室舒张末内径(LVEDD)、左室射血分数(LVEF)]变化;3凝血功能相关指标血浆组织因子(TF)活性、组织因子途径抑制物(TFPI)活性、D二聚体水平]。随访1年观察两组死亡率和再入院率。结果 1两组治疗3个月总有效率无显著差异(P0.05),治疗6个月观察组总有效率94.74%较对照组78.95%高,差异显著(P0.05);2两组治疗3个月、治疗6个月LVEDD相较无显著差异(P0.05),但观察组LVEF治疗3个月(42.8±4.5)%、治疗6个月(44.3±5.1)%分别较对照组(39.1±5.2)%、(40.6±5.3)%高,差异显著(P0.05);3观察组治疗3个月、6个月TF活性、D二聚体水平分别较对照组低,治疗6个月TF活性较对照组低,均差异显著(P0.05);4随访1年结果显示两组死亡率无显著差异(P0.05),但观察组因心力衰竭、出血事件等再入院率21.05%较对照组44.44%低(P0.05)。结论 CHF患者常规治疗基础上给予抗凝干预有助于提高临床疗效,心电图动态观察显示心功能恢复效果明显,血液高凝状态得到显著改善,有利于降低再入院率。

Effects of Chronic Heart Failure Anticoagulation Intervention on Electrocardiogram and Coagulation Function

Objective To study the dynamic effects of chronic heart failure (CHF) anticoagulation intervention on electrocardiogram and coagulation function,one year follow-up results were recorded.Methods 76 cases of CHF treated in department of cardiology of our hospital from April 2012 to October 2014 were selected,they were divided by random lot method into two groups.The control group (38 cases)received conventional treatment of anti heart failure in accordance with guidelines for the treatment of CHF,which included diuretics,angiotensin converting enzyme inhibitors or angiotensin receptor inhibitors,etc.The observation group (38 cases) taken anticoagulant drugs warfarin orally to maintain treatment.The following indexes were dynamic observed after the treatment of 3 months and 6 months respectively:①clinical efficacy of the two groups;②changes of echocardiographic heart function indexesleft ventricular end-diastolic dimension (LVEDD),left ventricular ejection fraction (LVEF)];③coagulation function related indexes plasma tissue factor(TF)activity,tissue factor pathway inhibitor (TFPI)activity,and D-dimer level].Death rate and readmission rate of the two groups were observed during 1 year follow-up.Results ①There was no significant difference in the total effective rate between the two groups after the treatment of 3 months (P ＞ 0.05),the total effective rate of the observation group after the treatment of 6 months was 94.74％,which was significantly higher than the control group (78.95％)(P ＜ 0.05);②There was no significant difference in LVEDD between the two groups after the treatment of 3 months and 6 months (P ＞ 0.05),but LVEF of the observation group after the treatment of 3 months (42.8 ± 4.5) ％ and after the treatment of 6 months (44.3 ±5.1) ％ were significantly higher than the control group (39.1 ± 5.2) ％,(40.6 ± 5.3) ％] (P ＜ 0.05);③TF activity and D-dimer level of the observation group after the treatment of 3 months and 6 months were significantly lower than the control group,TF activity after the treatment of 6 months was significantly lower than the control group (P ＜ 0.05);④There was no significant difference in death rate between the two groups during 1 year follow-up (P ＞ 0.05),but readmission rate of the observation group (21.05 ％) caused by heart failure and haemorrhage were significantly lower than the control group(44.44％) (P ＜ 0.05).Conclusion Giving CHF patients anticoagulation intervention on the basis of routine treatment is beneficial to improve the clinical efficacy,electrocardiogram dynamic observation shows that recovery effects of heart function is obvious,high blood coagulation state is significantly improved,it is beneficial to reduce readmission rate.