低分子肝素钠联合华法林及阿司匹林对风湿性心脏病左心房内血栓脱落致脑栓塞的临床研究效果

Clinical study of low molecular weight heparin sodium and warfarin combined with aspirin on left atrial thrombus disrupting cerebral embolism in patients with rheumatic heart disease

目的探讨低分子肝素钠与华法林联合阿司匹林对风湿性心脏病左心房内血栓脱落致脑栓塞患者的治疗效果。方法选取2013年12月至2016年12月胶州市人民医院收治的56例风湿性心脏病患者,随机分为对照组与研究组,每组28例。对照组采用阿司匹林治疗,研究组采用低分子肝素钠+华法林+阿司匹林治疗。统计比较两组治疗效果、凝血功能指标变化情况[凝血酶原活动度(PA)、部分凝血酶原时间(PT)、血小板聚集率(PAR)、活化部分凝血酶时间(APTT)]、不良反应发生情况。结果研究组治疗有效率(92.86%)高于对照组(64.29%),差异有统计学意义(P<0.05);治疗后两组PA、PT、APTT均高于治疗前,PAR低于治疗前,且研究组PAR低于对照组,差异均有统计学意义(均P<0.05);研究组不良反应发生率(17.85%)与对照组(25.00%)比较,差异无统计学意义(P>0.05)。结论低分子肝素钠与华法林联合阿司匹林治疗风湿性心脏病左心房内血栓脱落致脑栓塞患者疗效显著,且安全性较高。

Objective To investigate the clinical study of low molecular weight heparin sodium and warfarin combined with aspirin on left atrial thrombus disrupting cerebral embolism in patients with rheumatic heart disease.Methods From December 2013 to December 2016,56 patients with rheumatic heart disease in the Jiaozhou People＇s Hospital were randomly divided into control group and study group（n =28）,the control group was treated with aspirin,and the study group was treated with low molecular weight heparin ＋ warfarin ＋ aspirin.Treatment effect,coagulation function changes prothrombin activity（PA）,partial prothrombin time（PT）,platelet aggregation rate（PAR）,activated partial thrombin time（APTT） were statistically compared between the two groups.Results The effective rate in the study group（92.86%） was higher than in the control group（64.29%）,the difference was statistically significant（P〈0.05）; PAR,PT and APTT after treatment were higher than those before treatment,PAR was lower than before treatment,and PAR in the study group was lower than that in the control group,the difference was statistically significant（P〈0.05）; There was no significant difference in the incidence of adverse reactions between the study group（17.85%） and the control group（25.00%）（P〉0.05）.Conclusion Low molecular weight heparin and warfarin combined with aspirin is significantly effective in the treatment of rheumatic heart disease with left atrial thrombus for cerebral embolism,and the safety is high.