不同剂量利伐沙班对肺动脉栓塞维持期患者临床症状、血液指标及安全性影响

Effects of different doses of Rivaroxaban on clinical symptoms,blood indexes and safety in maintenance pulmonary embolism

目的探讨不同剂量利伐沙班对肺动脉栓塞(PE)维持期患者临床症状、血液指标及安全性的影响。方法选取自2020年2月至2022年10月南充市中心医院收治的176例PE患者为研究对象。按照随机数字表法将其分为A组(n=87)和B组(n=89)。两组均口服利伐沙班15 mg,每日2次。治疗21 d后,B组改口服利伐沙班20 mg,每日1次,连续服用3个月;A组改口服利伐沙班10 mg,每日1次,连续服用3个月。分析两组患者治疗前后的白细胞计数(WBC)、血小板计数(PLT)、纤维蛋白原(FIB)、动脉血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、心率(HR)、D-二聚体水平。观察治疗后患者症状缓解情况及治疗过程中出现的不良事件。治疗后随访1年,记录患者复发情况,维持治疗3个月时评价患者治疗的临床疗效。结果A组总有效率为94.25%(82/87),与B组的89.89%(80/89)比较,差异无统计学意义(P>0.05)。两组患者呼吸困难、胸痛、咳嗽缓解率比较,差异均无统计学意义(P>0.05)。两组治疗后PaO_(2)、PaCO_(2)均较治疗前升高,HR、WBC、PLT、FIB、D-二聚体水平均较治疗前降低,差异均有统计学意义(P<0.05)。两组患者治疗后HR、PaO_(2)、PaCO_(2)、WBC、PLT、FIB、D-二聚体比较,差异均无统计学意义(P>0.05)。两组患者皮肤黏膜出血、牙龈出血、皮疹、肝肾功能异常等不良反应发生率及复发率比较,差异均无统计学意义(P>0.05)。结论口服利伐沙班10 mg、每天1次与20 mg、每天1次在PE维持期中疗效相当,均可缓解患者的临床症状和血液指标,且具有较好的安全性。

Objective To explore the effects of different doses of rivaroxaban on clinical symptoms,blood indexes and safety in maintenance pulmonary embolism(PE).Methods A total of 176 PE patients admitted to Nanchong Central Hospital from February 2020 to October 2022 were selected as the research objects.They were divided into group A(n=87)and group B(n=89)according to random number table method.Both groups received 15 mg Rivaroxaban orally,twice a day.After 21 days of treatment,group B was given 20 mg Rivaroxaban orally,once a day,for 3 months.Group A was given Rivaroxaban 10 mg orally,once a day,for 3 months.The white blood cell count(WBC),platelet count(PLT),fibrinogen(FIB),oxygen partial pressure(PaO_(2)),carbon dioxide partial pressure(PaCO_(2)),heart rate(HR),D-dimer of the two groups were analyzed before and after treatment.The symptom relief of patients after treatment and adverse events during treatment were observed.The patients were followed up for 1 year after treatment and their recurrence was recorded.The clinical efficacy was evaluated after 3 months of maintenance treatment.Results The total effective rate of group A was 94.25%(82/87),which was not statistically significant compared with 89.89%(80/89)in group B(P>0.05).There were no significant differences in dyspnea,chest pain and cough relief rates between two groups(P>0.05).After treatment,PaO_(2)and PaCO_(2)in two groups were higher than those before treatment,while HR,WBC,PLT,FIB and D-dimer levels were lower than those before treatment,with statistical significance(P<0.05).There were no significant differences in HR,PaO_(2),PaCO_(2),WBC,PLT,FIB and D-dimer between two groups after treatment(P>0.05).There were no significant differences in the incidence and recurrence of adverse reactions such as skin mucosal bleeding,gingival bleeding,rash,abnormal liver and kidney function between two groups(P>0.05).Conclusion Oral Rivaroxaban 10 mg once a day is equivalent to oral Rivaroxaban 20 mg once a day in the maintenance of pulmonary embolism.It can relieve clinical symptoms and blood indexes,and has good safety.