116例老年肺栓塞患者3年随访分析  

Clinical analysis of 3 years follow-up in 116 elderly patients with pulmonary embolism

作　　者：陈阳[1] 陈茜薇[1] 罗加惠 朱菲白[1] 朱雅萍[1] 郭新贵[1] 史凯蕾[1] 

机构地区：[1]复旦大学附属华东医院心内科

出　　处：《老年医学与保健》2015年第4期230-233,共4页Geriatrics & Health Care

摘　　要：目的探讨溶栓和抗凝治疗在老年肺栓塞（pulmonary thromboembolism, PTE）患者中的疗效和安全性，以及长期使用华法林对减少PTE复发的效果。方法回顾性分析2008年10月-2011年10月入住华东医院心内科的116例PTE患者，年龄60～90岁，平均（69．1±8．0）岁，其中男性49例，女性67例。将所有PTE患者按《2008ESC急性肺栓塞诊断治疗指南》进行危险分层，高危患者（n=62）给予静脉内溶栓＋抗凝治疗，中低危患者（n=54）给予低分子肝素抗凝治疗，同时口服华法林治疗，密切监测INR水平。所有患者出院后1年内每3m随访一次，1年后每6m随访一次，记录抗凝疗程、PTE并发症及预后转归，并记录是否出现PTE复发事件。结果（1）在老年PTE患者中，高危组患者溶栓治疗有效率为93．5％（58／62），中低危组抗凝治疗有效率为85．2％（46／54）；（2）华法林抗凝治疗1年后停药的42例患者中，有10例出现复发性PTE，其中8例出现在停药6m内，其余2例出现在6～12m，停药1年后未再见复发病例。Logistic回归分析显示恶性肿瘤病史及停用华法林是PTE复发的独立危险因素；（3）老年PTE患者溶栓／抗凝＋华法林长期序贯治疗不增加出血风险。结论老年PTE患者根据危险分层给予溶栓或抗凝治疗是安全有效的。密切监测INR水平下延长应用华法林可以减少PTE复发，且不增加出血风险。Objective To explore the efficacy and safety of thrombolysis and anticoagulation therapy in elderly patients with pulmonary embolism, and the long-term effect of warfarin on the recurrence of pulmonary embolism. Methods Retrospective study of 116 cases with pulmonary embolism （PTE） patients in Hua-Dong hospital from Oct. 2008 to Oct. 2011 （49 male and 67 female） was conducted. The patients aged 60- 90, with the average （69.1 ± 8.0） years of age. All PTE patients were divided into two groups, the high-risk group （n = 62） were given intravenous thrombolysis and anticoagulation therapy, the low or medium-risk group （n = 54） were given low molecular heparin anticoagulation, both groups were given oral warfarin therapy at the same time, closly monitoring of INR levels. The patients were followed up for 3 years after discharge, and complications and prognosis of PTE outcome, recurrence events of PTE were observed. Results （1） The effective rate of thrombolysis treatment in the high-risk group of patients was 93.5% （58/62）, the effective rate of anticoagulant treatment in the low or medium-risk group was 85.2% （46/54）. （2） Among 42 cases who stopped taking warfarin after i years, 10 cases developed, recurrence of pulmonary embolism （of which 8 cases appearred within 6 months after warfarin discontinuance, the rest 2 cases appeared in 6 to 12 months）. Logistic regression analysis showed malignant tumor history and discontinued warfarin are independent risk factors for recurrence of pulmonary embolism. （3） Thrombolysis and （or） long-term sequential anticoagulant treatment with warfarin does not increase the risk of bleeding in elderly patients with pulmonary embolism. Conclusions Risk stratification for thrombolysis and anticoagulation therapy is safe and effective in elderly patients with pulmonary embolism. Close monitoring of INR levels and prolonged using warfarin can reduce the recurrence of pulmonary embolism, and do not increase the risk of bleeding.

关 键 词：老年 肺栓塞 抗凝 

分 类 号：R563.5[医药卫生—呼吸系统]