利伐沙班治疗急性肺栓塞的疗效观察

Observation on efficacy of rivaroxaban on acute pulmonary embolism

目的观察利伐沙班在急性肺栓塞(PE)抗凝治疗中的疗效及安全性。方法 60例急性非大面积肺栓塞患者,根据治疗方法不同分为利伐沙班组和华法林组,每组30例。利伐沙班组给予利伐沙班进行抗凝治疗,华法林组给予低分子肝素联合华法林进行抗凝治疗。比较两组患者的临床疗效、治疗前后的临床指标[呼吸频率(RR)、心率(HR)、动脉血氧分压(Pa O2)、二氧化碳分压(Pa CO2)、D-二聚体]变化及不良反应发生情况。结果华法林组的有效率为83.3%,利伐沙班组的有效率为86.7%,两组有效率比较差异无统计学意义(P>0.05)。治疗前两组患者临床指标比较差异无统计学意义(P>0.05);治疗后,两组患者临床指标与治疗前比较差异有统计学意义(P<0.05),但两组临床指标比较差异无统计学意义(P>0.05)。利伐沙班组患者未发生出血反应;华法林组患者发生4例出血反应,其中2例为牙龈出血,另2例为泌尿系出血,不良反应发生率为13.3%;利伐沙班组的出血不良反应发生率低于华法林组,差异有统计学意义(P<0.05)。结论利伐沙班治疗急性非大面积肺栓塞具有良好的临床疗效,且不良反应少,服用方便,值得临床进一步推广。

Objective To observe the efficacy and safety of rivaroxaban in anticoagulant treatment of acute pulmonary embolism（PE）. Methods A total of 60 patients with acute non-large area pulmonary embolism were divided by different treatment methods into rivaroxaban group and warfarin group, with 30 cases in each group. Rivaroxaban group received rivaroxaban for anticoagulant treatment, and warfarin group received low molecular weight heparin combined warfarin for anticoagulant treatment. Comparison were made on clinical efficacy, clinical indicators [respiration tate（RR）, heart rate（HR）, arterial oxygen partial pressure（Pa O2）, partial pressure of carbon dioxide（Pa CO2）, D-dimer] changes before and after treatment and occurrence of adverse reactions between the two groups. Results Warfarin group had effective rate as 83.3%, which was 86.7% in rivaroxaban group, and their difference was not statistically significant（P〈0.05）. Before treatment, both groups had no statistically significant difference in clinical indicators（P〈0.05）. After treatment, both groups had better clinical indicators than before treatment, and the difference was statistically significant（P〈0.05）. But both groups had no statistically significant difference in clinical indicators（P〈0.05）. Rivaroxaban group had no hemorrhagic reaction, and warfarin group had 4 cases of hemorrhagic reaction, including 2 cases of gingival bleeding and 2 cases of urinary bleeding, with incidence of adverse reaction as 13.3%. Rivaroxaban group had lower incidence of adverse reactions of bleeding than warfarin group, and the difference was statistically significant（P〈0.05）.Conclusion Rivaroxaban shows excellent clinical efficacy in treating acute non-large area pulmonary embolism with less adverse reactions. It is easy to take, and worthy of further clinical promotion.