低分子肝素钠治疗急性中危肺栓塞的效果

Effect of Low Molecular Weight Heparin Sodium on Acute Moderate-risk Pulmonary Embolism

目的 分析低分子肝素钠治疗急性中危肺栓塞的临床效果。方法 选取2020年1月—2022年12月于福建医科大学附属三明第一医院进行手术治疗的80例急性中危肺栓塞患者为研究对象,采用数字随机分组法将其分为试验组(40例)和对照组(40例)。2组均进行常规基础治疗,同时对照组采用华法林、阿替普酶治疗,试验组在对照组基础上采用低分子肝素钠治疗。比较2组治疗效果、不良反应发生情况、实验室指标(血清脑钠肽、肌钙蛋白、肺动脉收缩压)、凝血功能(凝血酶原时间、纤维蛋白原、活化部分凝血活酶时间)、炎症因子(白细胞介素-6、C反应蛋白)。结果 试验组治疗总有效率(97.50%)高于对照组(82.50%),差异有统计学意义(P=0.025)。试验组和对照组不良反应发生率(10.00%、7.50%)比较,差异无统计学意义(P=0.692)。治疗后,试验组血清脑钠肽、肌钙蛋白、肺动脉收缩压水平低于对照组,差异有统计学意义(P <0.001)。治疗后,试验组凝血酶原时间、活化部分凝血活酶时间长于对照组,纤维蛋白原水平低于对照组,差异有统计学意义(P <0.001)。治疗后,试验组白细胞介素-6、C反应蛋白水平[(1.02±0.19)pg/mL、(3.19±0.62)mg/L]低于对照组[(1.28±0.22)pg/mL、(4.25±0.72)mg/L],差异有统计学意义(P <0.001)。结论 低分子肝素钠治疗急性中危肺栓塞的临床效果良好,能有效改善血液黏滞度和炎症反应,减少肺动脉压,提高心脏输出量,且安全性好。

Objective To analyze the clinical effect of low molecular weight heparin sodium in the treatment of acute moderate-risk pulmonary embolism.Methods A total of 80 patients with acute moderate-risk pulmonary embolism who underwent surgical treatment in Sanming First Hospital Affiliated to Fujian Medical University from January 2020 to December 2022 were selected as the study objects,and were divided into experimental group(40 cases)and control group(40 cases)by digital randomization method.Both groups received conventional basic treatment,while the control group was treated with warfarin and alteplase,and the experimental group was treated with low molecular weight heparin sodium on the basis of the control group.The therapeutic effect,occurrence of adverse reactions,laboratory indexes(serum brain natriuretic peptide,troponin,pulmonary artery systolic pressure),coagulation function(prothrombin time,fibrinogen,activated partial thromboplastin time)and inflammatory factors(interleukin-6,C-reactive protein)were compared between the two groups.Results The total effective rate of experimental group(97.50%)was higher than that of control group(82.50%),and the difference was statistically significant(P=0.025).There was no significant difference in the incidence of adverse reactions between experimental group and control group(10.00%and 7.50%)(P=0.692).After treatment,the levels of brain natriuretic peptide,troponin and pulmonary artery systolic pressure in experimental groups were lower than those in control group,and the differences were statistically significant(P<0.001).After treatment,the prothrombin time and activated partial thromboplastin time of experimental group were longer than those of control group,and the fibrinogen level of experimental group was lower than that of control group,with statistical significances(P<0.001).After treatment,the prothrombin time and activated partial thromboplastin time of experimental group were longer than those of control group,and the fibrinogen level of experimental group was lower than that of control group,with statistical significances(P<0.001).After treatment,the levels of interleukin-6 and C-reactive protein in experimental group[(1.02±0.19)pg/mL,(3.19±0.62)mg/L]were lower than those in control group[(1.28±0.22)pg/mL,(4.25±0.72)mg/L],the differences were statistically significant(P<0.001).Conclusion Low molecular weight heparin sodium in the treatment of acute moderate-risk pulmonary embolism has good clinical effect,can effectively improve blood viscosity and inflammatory response,reduce pulmonary artery pressure,increase cardiac output,and good safety.