阿加曲班和低分子肝素治疗下肢动脉硬化闭塞症合并血栓的疗效比较

目的比较阿加曲班和低分子肝素治疗下肢动脉硬化闭塞症合并血栓的临床疗效。方法选取2017年1月—2017年9月在中国医科大学附属第一医院治疗的下肢动脉硬化闭塞症合并血栓患者60例,随机分为对照组(30例)和治疗组(30例)。两组患者给予基础溶栓治疗,经溶栓导管泵入注射用尿激酶,20~40万U加入到生理盐水中配成100 m L溶液,50 m L/h,2次/d。对照组患者在基础溶栓的基础上皮下注射低分子肝素钙4 100 AXa IU,2次/d;治疗组患者在基础溶栓的基础上经溶栓导管泵入阿加曲班注射液,40 mg加入到生理盐水320 m L中,20 m L/h,1次/d。两组患者均连续治疗7 d。评价两组患者临床疗效,同时比较治疗前后两组患者踝肱指数(ABI)、跛行距离和D-二聚体水平以及并发症和不良反应。结果治疗后,对照组和治疗组的总有效率分别为73.33%、93.33%,两组比较差异有统计学意义(P0.05)。两组患者的ABI和跛行距离均显著升高,同组治疗前后差异具有统计学意义(P0.05);且治疗组的跛行距离显著高于对照组,两组比较差异具有统计学意义(P0.05)。治疗第7天,两组患者的D-二聚体水平均显著降低,同组治疗前后比较差异具有统计学意义(P0.05);治疗第3天,治疗组的D-二聚体水平较治疗前显著降低,且显著低于对照组,两组比较差异具有统计学意义(P0.05)。对照组和治疗组的并发症发生率分别为6.67%、3.33%,两组比较差异有统计学意义(P0.05)。对照组和治疗组的不良反应发生率分别为13.33%、0,两组比较差异有统计学意义(P0.05)。结论阿加曲班联合尿激酶经导管溶栓治疗下肢动脉粥样硬化闭塞症合并血栓疗效显著,能明显改善相应症状,同时具有更好的安全性。

Comparison on clinical efficacy between argatroban and low molecular weight heparin in treatment of lower extremity atherosclerotic occlusive disease with thrombus

Objective To compare the clinical effect between argatroban and low molecular weight heparin in treatment of lower extremity atherosclerotic occlusive disease with thrombus. Methods Patients (60 cases) with lower extremity atherosclerotic occlusive disease with thrombus in The First Affiliated Hospital of China Medical University from January 2017 to September 2017 were randomly divided into control (30 cases) and treatment (30 cases) groups. Patients in two groups were pumped with Urokinase for injection by infusion catheter as basic thrombolysis, 2.0×10⁴-4.0×10⁴ units added into normal saline 100 mL, 50 mL/h, twice daily. Patients in the control group were subcutaneous injection administered with Low-molecular-weight Heparin Calcium Injection on the basis of basic thrombolysis, 4 100 AXaIU/time, twice daily. Patients in the treatment group were pumped with Argatroban Injection on the basis of basic thrombolysis, 40 mg added into normal saline 320 mL, 20 mL/h, once daily. Patients in two groups were treated for 7 d. After treatment, the clinical efficacy was evaluated, and the ABI, limping distance, D-dimer level, complication, and adverse reactions in two groups before and after treatment were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 73.33% and 93.33%, respectively, and there was difference between two groups (P<0.05). ABI and limping distance in two groups were significantly increased, and the difference was statistically significant in the same group (P<0.05). And limping distance in the treatment group was higher than that in the control group, with significant difference between two groups (P<0.05). On the treatment for 7 d, D-dimer level in two groups was significantly increased, and the difference was statistically significant in the same group (P<0.05). On the treatment for 3 d, D-dimer level in the treatment group was significantly decreased, and was lower than that in the control group, with significant difference between two groups (P<0.05). The rate of adverse reactions in the control and treatment groups were 13.33% and 0, respectively, and there was significant differencebetween two groups (P<0.05). Conclusion Argatroban combined with urokinase by infusion catheter thrombolysis has good effect in treatment of lower extremity atherosclerotic occlusive disease with thrombus, and can improve corresponding symptoms with good safety.