利伐沙班对心房颤动RFCA术后抗凝效果及肝肾功能影响  

Effect of rivaroxaban on anticoagulation and liver and kidney function after RFCA for atrial fibrillation

作　　者：潘永康 张川[1] PAN Yongkang;ZHANG Chuan(Department of Cardiology,Huzhou Central Hospital,Zhejiang 313000,China)

机构地区：[1]湖州市中心医院心内科,浙江湖州313000

出　　处：《中国现代医生》2023年第23期59-63,共5页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2023KY3160)。

摘　　要：目的探究对心房颤动(以下简称房颤)患者经导管射频消融术(radiofrequency catheter ablation,RFCA)后应用不同剂量利伐沙班的抗凝效果及其对肝肾功能的影响。方法选取2020年6月至2022年6月湖州市中心医院收治的150例经RFCA治疗的房颤患者,采用随机数字表法分为低剂量组(n=75)和标准剂量组(n=75)。低剂量组给予15mg利伐沙班,标准剂量组给予国际推荐量20mg利伐沙班。比较两组的抗凝效果[国际标准化比值(international normalized ratio,INR)、纤维蛋白原(fibrinogen,FIB)、D二聚体(D-dimer,D-D)]、肾功能[血尿素氮(blood urea nitrogen,BUN)、血肌酐(creatinine,Scr)、血尿酸(uric acid,UA)]、肝功能[天冬氨酸转氨酶(aspartate aminotransferase,AST)、丙氨酸转氨酶(alanine aminotransferase,ALT)]、心功能[左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricular end systolic diameter,LVESD)、左心室射血分数(left ventricular ejection fraction,LVEF)]、血清炎性标志物[同型半胱氨酸(homocysteine,Hcy)、超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)]及出血情况。结果与治疗前比较,治疗后两组INR均显著升高(P<0.05),但两组比较差异无统计学意义(P>0.05);血清Hcy、hs-CRP、FIB、D-D水平均显著降低(P<0.05),且与标准剂量组比较,低剂量组降低更显著(P<0.05)。两组治疗前后血清BUN、Scr、UA、AST、ALT水平及LVEDD、LVESD、LVEF比较,差异均无统计学意义(P>0.05)。低剂量组的出血发生率显著低于标准剂量组(P<0.05)。结论术后给予房颤患者RFCA低剂量利伐沙班,其抗凝效果不劣于标准剂量,低剂量利伐沙班有利于术后炎症反应的减轻,降低出血发生率,具有更安全、明显的临床效益。Objective To investigate the anticoagulant effect of different doses of rivaroxaban after radiofrequency catheter ablation(RFCA)in patients with atrial fibrillation and its influences on liver and kidney functions.Methods A total of 150 patients with atrial fibrillation treated with RFCA admitted to Huzhou Central Hospital from June 2020 to June 2022 were selected and divided into the low-dose group(n=75)and the standard-dose group(n=75)according to the random number table method.The low-dose group was given 15mg rivastaban,and the standard-dose group was given the internationally recommended dose of 20mg rivastaban.The anticoagulation effect[international normalized ratio(INR),fibrinogen(FIB),D-dimer(D-D)],renal function[blood urea nitrogen(BUN),creatinine(Scr),uric acid(UA)],liver function[aspartate aminotransferase(AST),alanine aminotransferase(ALT)],cardiac function[left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular ejection fraction(LVEF)],serum inflammatory markers[homocysteine(Hcy),high sensitivity C-reactive protein(hs-CRP)]and bleeding were compared between the two groups.Results Compared with pre-treatment,INR was significantly higher in both groups after treatment(P<0.05),but the difference between the two groups was not statistically significant(P>0.05).Serum Hcy,hs-CRP,FIB,and D-D levels were significantly reduced(P<0.05),and the reduction was more pronounced in the low dose group compared with the standard dose group(P<0.05).Comparison of serum BUN,Scr,UA,AST,ALT levels and LVEDD,LVESD,LVEF before and after treatment between the two groups showed no statistically significant difference(P>0.05).The incidence of bleeding in the low-dose group was significantly lower than that in the standard-dose group(P<0.05).Conclusion The anticoagulant effect of low-dose rivaroxaban in atrial fibrillation patients after RFCA is not inferior to that of standard-dose rivaroxaban.The low-dose rivaroxaban is beneficial to reduce postoperative inflammatory react

关 键 词：心房颤动 心导管射频消融术 利伐沙班 肝肾功能 抗凝效果 

分 类 号：R541.75[医药卫生—心血管疾病]