川芎嗪注射液联合低分子肝素钠对老年恶性肿瘤合并次大面积肺栓塞的疗效及其安全性观察

Clinical effect of ligustrazine injection combined with low molecular weight heparin sodium in the treatment of acute sub-massive pulmonary embolism in elderly patients with cancer

目的观察川芎嗪注射液联合低分子肝素钠对老年恶性肿瘤合并急性次大面积肺栓塞(ASPE)疗效及其安全性。方法将2013年1月至2017年1月我院收治的98例合并恶性肿瘤的老年ASPE病人作为研究对象,利用随机数字表法将其分为观察组和对照组,每组49例。病人均接受控制血压等基础治疗,对照组另给予静脉滴注低分子肝素钠,观察组在对照组的基础上给予盐酸川穹嗪注射液,2 m L/次,1次/d。2组的治疗时间均为14 d。治疗后评价2组疗效。治疗前后,检测并比较2组病人凝血指标[活化部分凝血活酶时间(APTT)、D-二聚体及凝血酶时间(TT)],血气指标[动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)]水平,右心功能指标[右房内径、右室直径、三尖瓣反流差压、肺动脉压、脑钠肽(BNP)及肌钙蛋白(c Tn I)]水平;治疗期间密切观察2组病人不良反应发生情况。结果治疗后,观察组总有效率为93. 8%,明显高于对照组的71. 4%(P<0. 05)。治疗后,观察组TT、APTT及D-二聚体水平均明显低于对照组(均P<0. 05)。治疗后,观察组各项血气指标及右心功能指标改善程度均明显优于对照组(均P<0. 05)。治疗期间,所有病人均未出现严重不良反应。结论川芎嗪注射液联合低分子肝素钠治疗合并恶性肿瘤的老年ASPE疗效较好,且安全性较高,值得进行深入探讨。

Objective To observe the clinical effect of ligustrazine injection combined with low molecular weight heparin sodium in the treatment of acute sub-massive pulmonary embolism（ASPE） in elderly cancer patients. Methods A total of 98 patients with cancer and ASPE from Jan. 2013 to Jan.2017 were randomly divided into observation group and control group,with 49 cases in each group. The patients were given conventional therapy,while the control group was treated with low molecular weight heparin sodium. The observation group was given ligustrazine injection on the basis of the control group.Both groups were treated for 14 days. After the treatment,the clinical effect was compared. Before and after the treatment,the levels of thrombin time（TT）,activated partial thrombin time（APTT）,brain natriuretic peptide（BNP）, cardiac tropoin I（cTnI）, D-Dimer, PaCO2,PaO2,right ventricular diameterand,tricuspid regurgitation,pulmonary artery pressure and differential pressure were detected and compared between the two groups. During the treatment,the adverse reactions were observed.Results The total effective rate in observation group was 93. 8 %,which was significantly higher than that（71. 4%） in control group（P<0. 05）. After the treatment,the levels of TT,APTT and D-Dimer in observation group were significantly lower than those in control group（P<0. 05）. After the treatment,the levels of PaCO2, PaO2, right ventricular diameterand, tricuspid regurgitation, pulmonary artery pressure,differential pressure,cTnI were more significantly improved in observation group than those in control group（P<0. 05）. There were no serious reverse actions in the two groups. Conclusions The method of ligustrazine injection combined with low molecular weight heparin sodium in the treatment of ASPE in elderly cancer patients has a good clinical effect and is worth to the intensive study.