利伐沙班联合尿激酶治疗急性肺动脉栓塞的临床研究

目的探讨利伐沙班片联合注射用尿激酶治疗急性肺动脉栓塞的临床疗效。方法选取2015年12月—2018年12月青海大学附属医院收治的100例急性肺动脉栓塞患者为研究对象,将所有患者采用随机数字表法分为对照组和治疗组,每组各50例。对照组患者静脉滴注注射用尿激酶,第1天,10万单位溶于100 mL生理盐水中,在30 min内静滴完成,第2天剂量改为50万单位,1次/d;治疗组患者在对照组基础上口服利伐沙班片,1片/次,1次/d。两组患者连续治疗10 d。观察两组的临床疗效,比较两组的临床症状缓解时间、血气指标、血液流变学指标。结果治疗后,对照组和治疗组的总有效率分别为78.00%、94.00%,两组比较差异有统计学意义(P0.05)。治疗后,治疗组患者呼吸困难、胸痛、紫绀和单侧肢体肿胀缓解时间均显著短于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者血氧分压(p O2)、血氧饱和度(SaO2)水平显著升高,二氧化碳分压(p CO2)水平显著降低,同组治疗前后比较差异有统计学意义(P0.05);并且治疗组患者血气指标水平明显优于对照组,两组比较差异有统计学意义(P0.05)。治疗后,两组患者纤维蛋白原(FIB)含量、血浆黏度(SV)、和红细胞压积(HCT)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);并且治疗组患者FIB、SV和HCT水平均明显低于对照组,两组比较差异有统计学意义(P0.05)。结论利伐沙班片联合注射用尿激酶治疗急性肺动脉栓塞具有较好的临床疗效,能缓解临床症状,调节血气指标和血液流变学指标,具有一定的临床推广应用价值。

Clinical study on rivaroxaban combined urokinase in treatment of acute pulmonary embolism

Objective To investigate the efficacy of Rivaroxaban Tablets combined Urokinase for injection in treatment of acute pulmonary embolism. Methods Patients (100 cases) with acute pulmonary embolism in Qinghai University Affiliated Hospital from December 2015 to December 2018 were randomly divided into control and treatment groups, and each group had 50 cases. Patients in the control group were iv administered with Urokinase for injection, at the first day, 100 000 U added into normal saline 100 mL, and completion of intravenous drip within 30 min, since the next day, the dose was changed to 500 000 U, once daily. Patients in the treatment group were po administered with Rivaroxaban Tablets on the basis of the control group, 1 tablets/time, once daily. Patients in two groups were treated for 10 d. After treatment, the clinical efficacies were evaluated, and clinical symptom remission time, blood gas indexes, and hemorheological indexes in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 78.00% and 94.00%, respectively, and there was difference between two groups (P<0.05). After treatment, the remission time of dyspnea, chest pain, cyanosis and unilateral limb swelling in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). After treatment, the levels of pO₂ and SaO₂ in two groups were significantly increased, but the levels of pCO₂ in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the blood gas indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). After treatment, the levels of FIB, SV, and HCT in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the hemorheological indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). Conclusion Rivaroxaban Tablets combined Urokinase for injection has clinical curative effect in treatment of acute pulmonary embolism, can alleviate clinical symptoms, regulate blood gas indexes and hemorheological indexes, which has a certain clinical application value.