左心耳封堵术、华法林、利伐沙班在非瓣膜性房颤病人卒中预防中的对比研究

目的 对比左心耳封堵术、华法林、利伐沙班在非瓣膜性房颤（NVAF）病人卒中预防中的治疗效果。方法 以2016年9月-2018年8月于辽宁省人民医院治疗的156例NVAF病人为研究对象，随机分为A组（左心耳封堵术）、B组（利伐沙班）、C组（华法林）3组，观察各组病人卒中发生率、出血事件发生率、治疗后3个月凝血功能指标及治疗后1个月、3个月肝肾功能指标。结果 A组病人均成功实施左心耳封堵术，有4例病人出现残余分流，分别为2mm、3mm、1mm、2mm，3个月后残余分流均消失，各组治疗期间未有严重药品反应及死亡病例；三组病人卒中发生率比较差异无统计学意义（P＞0.05）；A组出血事件发生率较C组低（P＜0.05），而B组与C组比较差异无统计学意义（P＞0.05）；三组病人凝血酶原时间（PT）、凝血酶时间（TT）、纤维蛋白原（FIB）比较差异无统计学意义（P＞0.05），且A组FIB较C组高，而活化部分凝血活酶时间（APTT）较B组、C组低，B组APTT也较C组低（P＜0.05）；三组病人治疗后1个月及3个月肝肾功能指标比较差异无统计学意义（P＞0.05）。结论 在预防NVAF病人卒中中，左心耳封堵术、华法林、利伐沙班均具有积极预防作用，而左心耳封堵术相对于华法林与利伐沙班更具有安全性，凝血效果更好。

A Comparative Study of Left Atrial Appendage Occlusion, Warfarin and Rivaroxaban in Stroke Prevention in Patients with Non-Valvular Atrial Fibrillation

Objective To compare the effects of left atrial appendage occlusion, warfarin and rivaroxaban on stroke prevention in patients with non-valvular atrial fibrillation (NVAF). Methods 156 NVAF patients treated in Liaoning People''s Hospital from September 2016 to August 2018 were studied, they were randomly divided into group A (left atrial appendage occlusion), group B (rivaroxaban) and group C (warfarin), the incidence of stroke, hemorrhage, coagulation function at 3 months after treatment and liver and kidney function at 1 and 3 months after treatment were observed. Results All patients in group A were successfully treated with left atrial appendage occlusion, four patients had residual shunt, were 2 mm, 3 mm, 1 mm and 2 mm respectively, the residual shunts disappeared after 3 months, no serious drug reactions and deaths occurred during the treatment; there was no significant difference in the incidence of stroke among the three groups (P > 0.05); the incidence of bleeding events in group A was lower than that in group C (P < 0.05), there was no significant difference between group B and group C (P > 0.05); there was no significant difference in prothrombin time (PT), thrombin time (TT) and fibrinogen (FIB) among the three groups (P > 0.05), FIB in group A was higher than that in group C, activated partial thromboplastin time (APTT) was lower than that in group B and group C, APTT in group B was also lower than that in group C (P < 0.05); there was no significant difference in liver and kidney function between the three groups at 1 and 3 months after treatment (P > 0.05). Conclusion Left atrial appendage occlusion, warfarin and rivaroxaban have positive preventive effects in the prevention of stroke in NVAF patients, compared with warfarin and rivaroxaban, left atrial appendage occlusion is safer and has better coagulation effect.