阿加曲班治疗下肢深静脉血栓及其并发症肺栓塞的临床疗效观察

目的 比较阿加曲班和普通肝素治疗下肢深静脉血栓及其并发症肺栓塞的临床疗效和不良反应。方法 将200例下肢深静脉血栓形成患者随机分成治疗组（100例）和对照组（100例），对照组患者入院后绝对卧床休息，患肢制动、抬高，忌按压、热敷；使用肝素钠抗凝，肝素钠注射液2 mL＋生理盐水10 mL，用微量泵以2 mL/h持续静脉泵入，治疗7 d后停用普通肝素，改为口服华法令治疗；使用注射用纤溶酶溶栓；合并肺栓塞者给予3 L/min吸氧及前列地尔扩张支气管。治疗组患者给予阿加曲班注射液抗凝，开始2 d，60 mg/d，持续静脉泵入；后5 d，20 mg/d，3 h内泵入，2 次/d。治疗7 d后改为口服华法令，其他治疗方案同对照组患者。治疗时间为2周，比较两组患者治疗前后症状和体征的变化，并在治疗过程中监测凝血酶原时间、活化部分凝血活酶时间及血小板。结果 治疗2周后，两组患者患肢疼痛、肿胀，肺栓塞患者咳嗽、咯血、呼吸困难等症状均有好转，治疗组患者症状改善更明显，且患肢周径较治疗前明显减小（P＜0.05），治疗组和对照组总有效率分别为98%、90%，两组比较差异有统计学意义（P＜0.05）。治疗组无血小板减少症（HIT）发生，对照组发生1例；对照组与治疗组相比，PT及APTT波动较大，差异有统计学意义（P＜0.05）。结论 阿加曲班治疗下肢深静脉血栓及其并发的肺栓塞与常规普通肝素治疗相比临床疗效及安全性均有提高，值得临床推广。

Clinical observation on argatroban in treatment of lower extremity deep venous thrombosis and its complication of pulmonary embolism

Objective To compare the curative effect and adverse reaction of argatroban and heparin in lower extremity deep venous thrombosis (DVT) and its complication of pulmonary embolism. Methods Patients (200 cases) with lower extremity DVT were randomly divided into the treatment (100 cases) and control (100 cases) groups. The patients in the control group were kept on absolute bed rest, at the same time, the affected limbs were avoided pressing and hot compress. The heparin sodium injection was used to anticoagulate, and the patients were administered with heparin sodium injection 2 mL in 10 mL normal saline, 2 mL/h, by iv continuous pumping, for 7 d. After 7 d, the heparin was instead by warfarin. Fibrinolytic enzyme injection was used for thrombolysis. The patients with pulmonary embolism were given 3 L/min oxygen and Alprostadil to dilate bronchus. Patients in the treatment group were administered with Argatroban Injection 60 mg/d by iv continuous pumping in first 2 d and 20 mg/d pumped in 3 h, twice daily in last 5 d. After 7 d, Argatroban Injection was instead by warfarin. Other approaches were the same as the control group. The period of the treatment was 2 weeks. Changes of symptoms and signs were compared between two groups, at the same time, PT, APTT, and platelet were also monitored. Results After the treatment, the limbs pain, swelling, symptoms of cough, hemoptysis, and breathing difficulties of all patients were improved. The symptoms in the treatment group were improved more obviously, and the perimeter of the suffered limb was significant decreased after the treatment (P < 0.05). The total efficacy rates in the treatment and control groups were 98% and 90%, respectively, and the difference was statistically significant (P < 0.05). There was no thrombocytopenia in the treatment group, whereas one heparin induced thrombocytopenia was found in the control group. Changes of prothrombin time and activated partial prothrombin time in the control group were more obvious than those in the treatment group (P < 0.05). Conclusion Argatroban has the better treatment efficacy and safety compared with traditional heparin in treatment of lower extremity DVT and its complication of pulmonary embolism, which is suitable for clinical usage.