低分子肝素长程抗凝与序贯抗凝治疗癌症相关急性肺血栓栓塞症疗效与安全性比较

Efficacy and Safety of Patients with Cancer Associated Acute Pulmonary Thromboembolism Treated by Low Molecular Weight Heparin Long Term Anticoagulant and Sequential Anticoagulation

目的比较低分子肝素长程抗凝与序贯抗凝治疗癌症相关急性肺血栓栓塞症(APTE)的疗效与安全性。方法选取2002年1月至2013年8月郯城县第一人民医院就诊的癌症患者出现APTE者80例,患者按照随机数字表法分为长程抗凝组和序贯抗凝组,各40例,分别接受低分子肝素长程抗凝治疗和低分子肝素长程序贯抗凝治疗,比较两种抗凝方法的有效性和安全性。结果临床症状观察显示,呼吸困难是两组患者最常见的临床症状。经两种抗凝治疗后,长程抗凝组动脉血氧分压(Pa O2)和氧合指数显著高于序贯抗凝组[(88±15)mm Hg(1 mm Hg=0.133 k Pa)比(72±16)mm Hg,(265±80)mm Hg比(229±80)mm Hg,P<0.01]、动脉血-肺泡气氧分压(PA-a O2)显著低于序贯抗凝组[(30±14)mm Hg比(39±14)mm Hg,P<0.01]。长程抗凝组治疗有效率为90.0%(36/40),序贯抗凝组治疗有效率为75.0%(30/40),长程抗凝组有效率显著高于序贯抗凝组(P<0.05)。两组患者血小板减少、出血和病死率比较,差异无统计学意义(P>0.05),长程抗凝组的再栓塞发生率间显著低于序贯抗凝组[2.5%(1/40)比20.0%(8/40),P<0.05]。结论低分子肝素长程抗凝较序贯抗凝治疗癌症相关APTE具有更好的疗效和安全性,可在临床推广使用。

Objective To compare the efficacy and safety of patients with cancer associated acute pulmonary thromboembolism（ APTE ） treated by low molecular weight heparin long term anticoagulation and sequential antigulation. Methods Total of 80 patients with cancer associated APTE in Tanehang First Peo- ple＇s Hospital from Jan. 2002 to Aug. 2013 were selected, and divided into two groups according to random number table method：long term low molecular weight heparin anticoagnlation group and sequential low molecular weight heparin group ,40 cases each. And the efficacy and safety of the two methods were compared. Results Observation on the clinical symptoms showed that the most common clinical symptoms of the two groups were dyspnea. After therapy, arterial oxygen partial pressure （ PaO2 ） and oxygenation index values of the long term anticoagulation group were significantly higher than the sequential anticoagulation group[ （88 ± 15） mmHg （ 1 mmHg = 0. 133 kPa） vs （72 ± 16） mmHg, （265 ± 80） mmHg vs （ 229 ±80） mmHg,P 〈 0. 01 ], the arterial-alveolar oxygen partial pressure （ PA-aO2 ） was significantly lower than the sequential anticoagulation group[ （30 ± 14） mmHg vs （39 ± 14） mmHg,P 〈0. 01 ]. The effeciacy of long term anticoagulation group was 90. 0% ,and of the sequential anticoagulatian group was 75.0% ,the former had a significantly higher efficacy （P 〈 0. 05 ）. The thrombocytopenia,hemorrhage, and death rate of the two groups had no statistically significant differences （P 〉 0. 05 ）,and embolism incidence of the long term anticoagulation group was significantly lower than the other group,the difference was statistically significant [ 2. 5% （1/40） vs 20. 0% （8/ 40） ,P 〈0. 05 ]. Conclusion Patients with cancer associated APTE have achieved better efficacy and safety from long term low molecular weight heparin anticoagnlation than sequential anticoagulation.