左心耳封堵术与华法林及利伐沙班在非瓣膜性心房颤动患者卒中预防中的对比研究

Left atrial appendage occlusion,Warfarin and Rivaroxaban in stroke prevention in patients with nonvalvular atrial fibrillation

目的对比左心耳封堵术、华法林和利伐沙班在非瓣膜性心房颤动(NVAF)患者卒中预防中的治疗效果。方法以2016年9月至2018年8月于辽宁省人民医院治疗的156例NVAF患者为研究对象,釆用随机数字表法分为A组(左心耳封堵术)、B组(利伐沙班)、C组(华法林)三组,观察各组患者卒中发生率、出血事件发生率、治疗后3个月凝血功能指标及治疗后1个月、3个月肝肾功能指标。结果A组均成功实施左心耳封堵术,有4例患者出现残余分流,分别为2 mm、3 mm J mm和2 mm,3个月后残余分流均消失,各组治疗期间未有严重药品反应及死亡病例;三组患者卒中发生率比较差异无统计学意义(P>0.05);A组出血事件发生率为3.85%(2/52)较C组低19.23%(10/52)(P<0.05),而B组与C组比较差异无统计学意义(P>0.05);三组患者凝血酶原时间(PT)、凝血酶时间(TT)和纤维蛋白原(FIB)比较差异无统计学意义(P>0.05),且A组FIB为(2.86±0.41)g/L较C组高(2.68±0.37)g/L,而活化部分凝血活酶时间(APTT)为(37.28±4.51)s较B组(39.06±4.27)s和C组(44.93±5.36)s短,B组APTT也较C组短(P<0.05);三组患者治疗后1个月及3个月肝肾功能指标比较差异无统计学意义(P>0.05)o结论在预防NVAF患者卒中中,左心耳封堵术、华法林、利伐沙班均具有积极预防作用,而左心耳封堵术相对于华法林与利伐沙班更具有安全性,具有临床推广应用价值。

Objective To compare the effects of left atrial appendage occlusion,Warfarin and Rivaroxaban on stroke prevention in patients with non-valvular atrial fibrillation(NVAF).Methods 156 NVAF patients treated in Liaoning People's Hospital from September 2016 to August 2018 were enrolled and random number table method was used to randomly divide them into group A(left atrial appendage occlusion),group B(Rivaroxaban)and group C(Warfarin).The incidence of stroke,hemorrhage,coagulation function at 3 months after treatment and liver and kidney function at 1 and 3 months after treatment were observed.Results All the patients in group A were successfully treated with left atrial appendage occlusion;4 patients had residual shunt of 2 mm,3 mm,1 mm and 2 mm respectively and the residual shunts disappeared after 3 months.No serious drug reactions and deaths occurred during the treatment;there was no significant difference in the incidence of stroke among the three groups(P>0.05).The incidence of bleeding events in group A was 3.85%(2/52),lower than that in group C 19.23%(10/52)(P<0.05);there was no significant difference between group B and group C(P>0.05).There was no significant difference in prothrombin time(PT),thrombin time(TT)and fibrinogen(FIB)among the three groups(P>0.05).FIB in group A was(2.86±0.41)g/L,higher than that in group C(2.68±0.37)g/L;activated partial thromboplastin time(APTT)was(37.28±4.51)s,lower than that in group B(39.06±4.27)s and group C(44.93±5.36)s.APTT in group B was also lower than that in group C(P<0.05).There was no significant difference in liver and kidney function between the three groups at 1 and 3 months after treatment(P>0.05).Conclusion Left atrial appendage occlusion,Warfarin and Rivaroxaban have positive preventive effects in the prevention of stroke in NVAF patients.Compared with Warfarin and Rivaroxaban,left atrial appendage occlusion is safer and has the clinical application value.