28例次大面积肺血栓栓塞症单纯抗凝治疗临床效果分析  

Effect of anticoagulant therapy on submassive pulmonary thromboembolism： a case series of 28 patients

作　　者：郑宏[1] 

机构地区：[1]连云港市第一人民医院呼吸内科,222002

出　　处：《国际呼吸杂志》2013年第24期1867-1869,共3页International Journal of Respiration

摘　　要：目的观察低分子肝素联合华法林治疗急性次大面积肺血栓栓塞症的有效性。方法对28例确诊的急性次大面积肺血栓栓塞症患者，立即给予低分子肝素皮下注射5～7d，48h后开始重叠应用华法林口服3～5d，此后单独口服华法林治疗，观察患者治疗前后的临床症状与体征、动脉血气分析及螺旋CT肺动脉造影的变化，并随访1年。结果28例患者中无效1例，恶化1例，2例患者因并发多器官功能衰竭在治疗后2周内死亡，1例患者在半年至1年内死亡，其余患者临床症状和影像学异常、右心室室壁运动幅度和肺动脉压得到有效改善，其中近控5例，显效7例，好转11例。随访期间，有3例患者再次出现肺栓塞。结论次大面积肺血栓栓塞症患者应用低分子肝素和口服华法林抗凝治疗安全、有效，不良反应小。Objective To evaluate the effect of low molecular heparin plus warfarin on acute submassive pulmonary thromboembolism. Methods Low molecular heparin was immediately used in 28 patients with acute submassive pulmonary thromboembolism for five to seven days. Warfarin was added after 48 hours of low molecular heparin therapy, after three to five days warfarin was used alone. The clinical manifestations, blood gas and SCTPA were observed. The duration of follow up was one year. Results Of 28 cases,one case had no response,one case deteriorated,~wo cases died of multiple organ failure, and one patient died between six months and 12 months. The clinical manifestations, radiology abnormality,and colour sonography in the others were improved. During the follow up, three patients had pulmonary thromboembolism again. Conclusions It is safe and effective to use low molecular heparin plus warfarin in submassive pulmonary thromboembolism.

关 键 词：肺血栓栓塞症 低分子肝素 华法林 抗凝疗法 

分 类 号：R563.5[医药卫生—呼吸系统]