抗凝治疗在危重型新型冠状病毒肺炎合并静脉血栓栓塞症中的应用  

Application of anticoagulation therapy in critically ill patients with coronavirus disease 2019 complicated with venous thromboembolism

作　　者：张冬[1] 余艳琴[2] 刘静怡 何慧洁[1] 王慧敏[1] 孙建芳[1] 马耀[1] 赵子龙[1] 逯学梅[1] 石继海[1] Zhang Dong;Yu Yanqin;Liu Jingyi;He Huijie;Wang Huimin;Sun Jianfang;Ma Yao;Zhao Zilong;Lu Xuemei;Shi Jihai(The First Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology,Baotou 014010,Inner Mongolia Autonomous Region,China;Clinical Epidemiology Research Center of Baotou Medical College,Baotou 014010,Inner Mongolia Autonomous Region,China)

机构地区：[1]内蒙古科技大学包头医学院第一附属医院,内蒙古自治区包头014010 [2]包头医学院临床流行病学研究中心,内蒙古自治区包头014010

出　　处：《中国中西医结合急救杂志》2021年第3期267-269,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：内蒙古自治区包头市科技计划项目(2020Z1001);包头医学院科研基金(BYJJ-XG[ZC]202025,BYJJ-XG[ZC]202022,BYJJ-XG[ZC]202010)。

摘　　要：目的探讨抗凝治疗在危重型新型冠状病毒肺炎(新冠肺炎)合并静脉血栓栓塞症(VTE)患者中的应用效果.方法收集2020年1月30日至3月7日内蒙古科技大学包头医学院第一附属医院收治的3例危重型新冠肺炎患者的临床资料,记录患者的症状及辅助检查情况、治疗方法及预后,分析抗凝治疗对患者VTE的影响.结果3例患者中,2例行无创机械通气治疗,1例行有创-无创序贯通气治疗.3例患者中有1例合并双下肢深静脉血栓形成(DVT),1例合并颈内静脉和无名静脉血栓形成及肺血栓栓塞.所有患者D-二聚体和纤维蛋白原降解产物(FDP)水平均明显升高,D-二聚体水平分别为3.34 mg/L、2.46 mg/L、3.12 mg/L,FDP水平分别为27.95 mg/L、23.46 mg/L、26.53 mg/L.在严密观察出血情况下,给予患者低分子肝素、磺达肝癸钠或利伐沙班治疗,最终患者均治愈出院.结论在严密监测患者出血的情况下,对新冠肺炎合并VTE患者给予抗凝治疗为有效手段.Objective To explore the application effect of anticoagulation therapy on critically ill patients with coronavirus disease 2019(COVID-19)complicated with venous thromboembolism(VTE).Methods The clinical data of 3 critically ill patients with COVID-19 admitted in the department of respiratory medicine of the First Hospital of Baotou Medical College Affiliated to the Inner Mongolia University of Science and Technology from January 30 to March 7,2020 were collected.The patients'symptoms and auxiliary examination situations,therapeutic methods and prognosis were recorded,and the effect of anti-coagulation treatment on patients'VTE was analyzed.Results Among the 3 patients,2 cases were treated with noninvasive mechanical ventilation and 1 case was treated by invasive-noninvasive continuous ventilation.Among the 3 patients,1 patient was complicated by deep vein thrombosis(DVT)of both lower extremities,and 1 patient had internal jugular vein and brachiocephalic vein thrombosis and pulmonary thromboembolism.The patients all showed marked increase in the levels of D-dimer and fibrinogen degradation products(FDP).The D-dimer values of 3 patients were 3.34 mg/L,2.46 mg/L,3.12 mg/L,and their fibrin degradation products levels were 27.95 mg/L,23.46 mg/L,26.53 mg/L respectively.Under strict observation of bleeding situation,all the patients received treatment of low-molecular-weight heparin or fondaparinux or rivaroxaban,and finally all the patients were cured and discharged.Conclusion Under the situation of strictly monitoring the bleeding,the anticoagulation treatment is an effective therapy for patients with COVID-19 complicated by venous thromboembolism.

关 键 词：新型冠状病毒肺炎 抗凝治疗 静脉血栓栓塞症 

分 类 号：R47[医药卫生—护理学]