瑞替普酶联合华法林和低分子肝素在高危急性肺栓塞患者中的应用  

Application of reteplase combined with warfarin and low molecular weight heparin in high-risk acute pulmonary embolism patients

作　　者：陈新 李丹 郭小丽 朱光辉[1] 何莉 梁茜雯 Chen Xin;Li Dan;Guo Xiaoli;Zhu Guanghui;He Li;Liang Qianwen(Department of Pharmacy,Suining Municipal Hospital of TCM/Suining Hospital of TCM Affiliated to North Sichuan Medical College,Suining Sichuan 629000,China;Department of Pharmacy,Suining Central Hospital,Suining Sichuan 629000,China;Department of Pharmacy,Chengdu Seventh People's Hospital,Chengdu 610021,China)

机构地区：[1]四川省遂宁市中医院/川北医学院附属遂宁中医医院药剂科,四川遂宁629000 [2]四川省遂宁市中心医院药剂科,四川遂宁629000 [3]成都市第七人民医院药剂科,成都610021

出　　处：《保健医学研究与实践》2024年第9期24-29,共6页Health Medicine Research and Practice

基　　金：四川省科技计划项目(2022YFQ0028)。

摘　　要：目的探讨瑞替普酶联合华法林和低分子肝素在高危急性肺栓塞患者中的应用效果,以期为急性肺栓塞患者的治疗提供参考。方法回顾性分析遂宁市中医院2020年8月—2023年5月收治的101例高危急性肺栓塞患者的临床资料,按照治疗方案分为对照组(48例)和观察组(53)例。对照组患者采用华法林联合低分子肝素治疗,观察组患者在对照组基础上联用瑞替普酶进行治疗。比较2组患者的临床疗效,治疗前后的凝血功能指标、血管内皮功能指标、炎症因子水平及治疗期间不良反应发生情况。结果观察组患者的治疗总有效率为88.68%(47/53),高于对照组的68.75%(33/48),差异有统计学意义(χ^(2)=6.075,P=0.014)。治疗前,2组患者活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)及纤维蛋白原(FiB)水平比较,差异均无统计学意义(P>0.05);治疗后,2组患者APTT、PT、TT均长于治疗前且观察组均长于对照组,FiB水平均低于治疗前且观察组低于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者血清内皮素-1(ET-1)、血栓素B2(TXB2)、可溶性细胞间黏附分子-1(sICAM-1)及一氧化氮(NO)水平比较,差异均无统计学意义(P>0.05);治疗后,2组患者血清ET-1、TXB2、sICAM-1水平均低于治疗前且观察组均低于对照组,血清NO水平均高于治疗前且观察组高于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者血清白介素-10(IL-10)、C反应蛋白(CRP)水平比较,差异均无统计学意义(P>0.05);治疗后,2组患者血清IL-10、CRP水平均低于治疗前,且观察组均低于对照组,差异均有统计学意义(P<0.05)。对照组和观察组患者不良反应发生率为12.50%和7.52%,差异无统计学意义(χ^(2)=0.249,P=0.618)。结论瑞替普酶联合华法林和低分子肝素治疗高危急性肺栓塞的效果较好,不仅可有效改善患者的凝血功能及血管内皮功能,还可抑制炎症因子水平升高,Objective To explore the application effect of reteplase combined with warfarin and low molecular weight heparin in the treatment of high-risk acute pulmonary embolism(PE)patients,in order to provide a reference for treating acute PE patients.Methods A retrospective analysis was conducted on the clinical data of 101 high-risk acute PE patients admitted to Suining Municipal Hospital of TCM from August 2020 to May 2023.The patients were assigned to the control group(48 cases)and the observation group(53 cases)according to the treatment regimen.The control group was treated with warfarin combined with low molecular weight heparin,while the observation group was treated with reteplase in addition to the regimen used in the control group.The clinical efficacy,coagulation function indicators,vascular endothelial function indicators,inflammatory factor levels,and adverse reactions during treatment were compared between the two groups.Results The overall response rate in the observation group was significantly higher than that in the control group[88.68%(47/53)vs.68.75%(33/48);χ^(2)=6.075,P=0.014].Before treatment,no significant differences were noted in activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),and fibrinogen(FiB)levels between the two groups(P>0.05).After treatment,APTT,PT,and TT were increased in both groups,and the observation group had longer values than the control group;FiB levels were decreased,with the observation group showing lower levels than the control group,all with significant differences(P<0.05).Before treatment,no significant differences were found in serum endothelin-1(ET-1),thromboxane B2(TXB2),soluble intercellular adhesion molecule-1(sICAM-1),and nitric oxide(NO)levels between the two groups(P>0.05).After treatment,serum levels of ET-1,TXB2,and sICAM-1 showed reductions in both groups,with the observation group having lower levels than the control group;serum NO levels indicated an increase,with the observation group having higher levels than the control gro

关 键 词：瑞替普酶 华法林 低分子肝素 高危 急性肺栓塞 凝血功能 血管内皮功能 炎症反应 安全性 

分 类 号：R563.5[医药卫生—呼吸系统]