低分子肝素钙和利伐沙班联合阿托伐他汀对急性肺栓塞患者相关指标的影响  

Effects of Low Molecular Weight Heparin Calcium and Rivaroxaban Combined with Atorvastatin on Related Indexes in Patients with Acute Pulmonary Embolism

作　　者：许坤[1] 赵弘卿[1] 冯金萍[1] 朱湘芸[1] 韩曙光[1] 王洵[1] XU Kun ZHAO Hongqing FENG Jinping ZHU Xiangyun HAN Shuguang WANG Xun(Dept. of Respiratory Medicine, Wuxi Second People＇s Hospital, Jiangsu Wuxi 214002, China)

机构地区：[1]无锡市第二人民医院呼吸科,江苏无锡214002

出　　处：《中国药房》2017年第21期2940-2943,共4页China Pharmacy

摘　　要：目的:探讨低分子肝素钙和利伐沙班联合阿托伐他汀对急性肺栓塞患者相关指标的影响。方法:回顾性分析72例急性肺栓塞患者资料,根据治疗方案的不同分为A组(21例)、B组(26例)和C组(25例)。A组患者入院后立即肌内注射低分子肝素钙注射液2 d后加用华法林钠片,7 d后停用低分子肝素钙注射液,继续服用华法林3~6个月。B组患者给予低分子肝素钙注射液(用法用量同A组),2 d后加用利伐沙班片7 d后停用低分子肝素钙注射液,继续服用利伐沙班3~6个月。C组患者在B组治疗的基础上给予阿托伐他汀钙片,持续3~6个月。观察3组患者呼吸困难、胸痛、发绀消失时间,治疗前后心率(HR)、动脉血氧分压[pa(O2)]、动脉血二氧化碳分压[pa(CO2)]、C反应蛋白(CRP)、D-二聚体(D-D)、肿瘤坏死因子α(TNF-α)、白细胞介素1(IL-1)、IL-6、内皮素1(ET-1)、一氧化氮(NO)水平,临床终点事件发生情况和不良反应发生情况。结果:患者呼吸困难、胸痛、发绀消失时间A组>B组>C组,差异均有统计学意义(P<0.05)。治疗前,3组患者HR、pa(O2)、pa(CO2)、CRP、IL-1、IL-6、TNF-α、DD、ET-1、NO水平比较,差异均无统计学意义(P>0.05)。治疗后,3组患者HR均显著低于同组治疗前,且A组<B组<C组;3组患者pa(O2)、pa(CO2)均显著高于同组治疗前,且A组>B组>C组,组间比较差异均有统计学意义(P<0.05)。治疗后,3组患者CRP、IL-1、IL-6、TNF-α、D-D水平均显著低于同组治疗前,且C组<A、B组,差异均有统计学意义(P<0.05);但A、B组比较,差异均无统计学意义(P>0.05)。治疗后,3组患者ET-1水平均显著低于同组治疗前,且C组<B组<A组;3组患者NO水平均显著高于同组治疗前,且C组>B组>A组,差异均有统计学意义(P<0.05)。C组患者临床终点事件发生率显著低于A组,B组患者不良反应发生率显著低于A组,差异均有统计学意义(P<0.05)。结论 :低分子肝素钙和利伐沙班联合阿托伐他汀可显OBJECTIVE： To investigate the effects of low molecular weight heparin calcium and rivaroxaban combined with atorvastatin on related indexes in patients with acute pulmonary embolism （APE）. METHODS： The data of 72 APE patients were analyzed retrospectively. According to treatment plan, the patients were divided into group A （21 cases）, group B （26 cases） and group C （25 cases）. Group A was treated with intramuscular injection of Low molecular heparin calcium injection immediately after admission; 2 days later, they were given Warfarin sodium tablets; 7 days later, Low molecular heparin calcium injection was stopped while warfarin was still administrated, lasting for 3-6 months. Group B was given Low molecular heparin injection（same usage and dose as group A）; 2 days later, they were additionally treated with Rivaroxaban tablets; 7 days later, Low molecular heparin calcium injection was stopped while rivaroxaban was still administrated, lasting for 3-6 months. Based on the treatment in group B, group C was treated with Atorvastatin calcium tablets 20 mg orally, once a day in the evening, lasting for 3-6 months. The time of dyspnea,chest pain and cyanosis disappearance were observed in 3 groups as well as the levels of HR,pa（O2）,pa（CO2）, CRP, D-dimer, TNF-α, IL-1, IL-6, ET-1 and NO before and after treatment. The occurrence of clinical outcome events and ADR were also observed. RESULTS： The time of dyspnea, chest pain and cyanosis disappearance in group A were longer than group B, and the group B was longer than the group A, with statistical significance （P〈0.05）. Before treatment, there was no statistical significance in the levels of HR, pa（O2）,pa（CO2）, CRP, IL-1, IL-6, TNF-α, D-D, ET-1 and NO among 3 groups （P〉0.05）. After treatment, HR of 3 groups were all lower than before, and they showed group A〈group B〈group C; the levels of pa（O2） and pa（CO2） in 3 groups were all significantly higher than before, and they showed group A〉group B〉group C,

关 键 词：急性肺栓塞 低分子肝素钙 利伐沙班 阿托伐他汀 安全性 

分 类 号：R563[医药卫生—呼吸系统]