华法林预防老年非瓣膜性心房颤动患者血栓栓塞临床研究

Clinical Study of Warfarin in Preventing the Thromboembolism of Elderly Patients with Nonvalvular Atrial Fibrillation

目的探讨华法林预防老年非瓣膜性心房颤动患者血栓栓塞的治疗效果及应用价值。方法选择2010年3月至2013年3月泸州市第四人民医院心内科治疗的老年非瓣膜性心房颤动患者88例,按照随机数字表法分为两组。对照组(44例)给予阿司匹林(每日1次,每次0.1 g,睡前口服)治疗,观察组(44例)给予华法林(初始剂量2.5 mg/d,之后根据凝血功能调整,每次增减0.625 mg,口服给药)联合胺碘酮(初始剂量每次0.2 g,每日3次,治疗2周后每次0.2 g,每日1次,口服给药)治疗。观察两组患者的临床治疗情况。结果观察组患者左心室射血分数和左心房内径改善情况优于对照组,差异有统计学意义(P<0.01)。观察组患者栓塞事件发生率和出血并发症发生率均低于对照组,差异有统计学意义(P<0.05或P<0.01)。结论采用华法林联合胺碘酮预防老年非瓣膜性心房颤动患者血栓栓塞效果可靠,可减少出血并发症发生,同时可以改善患者左心室射血分数和左心房内径。

Objective To explore the therapeutic effect and application value of warfarin in prevention of thromboembolism in elderly patients with nonvalvular atrial fibrillation. Methods A total of 88 elderly patients with nonvalvular atrial fibrillation were chosen in Luzhou City Fourth People＇s Hospital from Mar. 2010 to Mar. 2010. According to random number-table method the patients were divided into two groups： control group （44 cases ） and observation group （44 cases ）. The control group was treated with aspirin （0.1 g/time,1 time/d,orally at bedtime） treatment, while the observation group was treated with warfarin （after the initial dose of 2.5 mg/d,according to blood eeagulation function adjustment,increase or decrease by 0. 625 mg each time, orally） joint amiodarone （ initial dose of 0. 2 g/time, 3 times/d, after treatment for 2 weeks,0.2 g/time, 1 time/d, orally ） treatment. The clinical treatment effect of the two groups were observed. Results Improvement of left ventricular ejection fraction and left atrial diameter of the observation group was better.than that Of the control group, the difference was statistically significant （ P 〈 0.01 ）. Incidences of embol- ism and bleeding complications of the observation group were lower than the control group, the difference was statistically significant （ P 〈 0.05 or P 〈 0. 01 ）. Conclusion Amiodarone combined with warfarin joint pre- vention of thromboembolism in elderly patients with nonvalvular atrial fibrillation has reliable effect, which can reduce bleeding complications, and improve left vantricular ejection fraction and left atrial diameter.