大剂量丹参多酚治疗85岁以上高龄老年急性深静脉血栓形成的疗效及安全性分析  

Efficacy and safety of high-dose Salvianolate treatment in more than 85 elderly patients with acute deep vein thrombosis

作　　者：赵尚敏[1] 史凯蕾[2] 黎博[1] 

机构地区：[1]复旦大学附属华东医院消化内科,上海市200040 [2]复旦大学附属华东医院心内科,上海市200040

出　　处：《老年医学与保健》2014年第6期430-433,共4页Geriatrics & Health Care

摘　　要：目的 应用大剂量丹参多酚治疗85岁以上急性深静脉血栓形成患者,评价其疗效及安全性.方法 45例经超声证实为急性深静脉血栓形成的高龄老年患者,男性38例,女性7例,年龄86 ～ 97岁,平均年龄（90.3±2.7）岁.根据治疗方案分为丹参多酚组30例,连续14d给予400 mg丹参多酚静脉滴注;低分子肝素组15例,连续14d给予依诺肝素0.4 mL皮下注射.结合临床表现和超声结果评价疗效及不良反应;同时记录治疗前后血常规、肝肾功能、凝血功能变化.结果 丹参多酚组治疗后起效时间2～5d,平均3.07 d;患肢治愈23例（76.7％）,显效5例（16.7％）,有效1例（3.3％）,总有效率96.7％.低分子肝素组治疗后起效时间2～6d,平均4.00 d;患肢治愈8例（53.3％）,显效3例（20％）,有效1例（6.7％）,总有效率80％.丹参多酚组所有病例治疗期间均未出现不良反应,低分子肝素组有1例患者出现肝素注射处皮下出血,1例患者出现牙龈出血.大剂量丹参多酚治疗降低患者纤维蛋白原（fibrinogen,Fg）水平[（4.18±0.54） g/L vs （3.45±0.15） g/L,P＜0.05]和D-二聚体水平[（6.42±2.61） vs （2.37±0.59）,P＜0.01],对凝血酶原时间、活化部分凝血活酶时间、凝血酶时间及肝肾功能、白细胞和血小板没有影响（P＞0.05）.结论 应用大剂量丹参多酚治疗85岁以上高龄老年深静脉血栓形成患者具有较好的疗效和安全性,可以降低患者Fg和D-二聚体水平,但不增加出血风险和肝肾功能损害.Objective We analyzed the efficacy and safety of high-dose Salvianolate treatment in those more than 85 years patients with acute deep vein thrombosis. Methods Forty-five very elderly cases who were confirmed by ultrasound with acute deep vein thrombosis were enrolled. We divided the patients into two groups： 30 cases were given Salvianolate 400 mg intravenously for consecutive 14 days （ Salvianolate group） and 15 cases were given enoxaparin 0.4 mL subcutaneous injection for continuous 14 days（ LMWH group）. We evaluated the efficacy and adverse reactions with clinical and ultrasound results; while recording blood count, liver and renal function, blood coagulation before and after treatment. Results Salvianolate group of 30 patients catch up effect time of 2-5 days, and average of 3.07 days. After 14 days therapy, 23 （76.7%） patients were complete cured, 5 （16.7%） cases were markedly improved and 1 （3.3%） case were effective. Thetotalefficiencyis96.7%, and nobody has subcutaneous bleeding, hypotension and other adverse reactions. InLMWH group, the effect time is about 2-6 days, and average of 4.00 days. After 14 days treatment, 8 （53.3 %） patients were complete cured, 3 （20%） cases were markedly improved and 1 （6.7%） case were effective. The total efficiency is 96.7%. One patient had subcutaneous bleeding and another had gingival bleeding, Comparing with the previous treatment, high- doses therapy Salvianolate lower fibrinogen levels [（4.18 ± 0.54） g/L vs （3.45 ± 0.15） g/L, P〈 0.05）, and D - dimer level [（6.42± 2.61） vs （2.37 ±0.59）, P〈0.01], while PT, APTT, TT andliver and renal function, white blood cells and platelets had no significant effect （P〉 0.05）. Conclusion High-dose Salvianolate therapy in very elderly of deep vein thrombosis has better efficacy and safety, reduce fibrinogen and D- dimer levels, but does not increase the risk of bleeding and liver and renal function.

关 键 词：深静脉血栓 丹参多酚 老年人 

分 类 号：R364.15[医药卫生—病理学]