【摘要】 目的探讨不同抗凝方案对老年肺栓塞患者的疗效及影响。方法回顾性连续纳入2010年1月至2015年7月上海市嘉定区中心医院收治的老年肺栓塞患者70例。所有患者均给予低分子肝素及华法林维持抗凝治疗。根据抗凝目标国际标准化比值(INR)是否达到2.5,将患者分为高抗凝组(n=23,INR≥2.5)和低抗凝组(n=47,INR<2.5),比较2组患者的华法林用量调整情况、抗凝疗效及影响。应用SPSS 19.0统计软件进行数据分析。根据数据类型采用t检验、非参数检验(Mann-Whitney U检验)、卡方检验或Fisher确切检验进行比较。结果所有老年肺栓塞患者的临床表现以呼吸困难(68.6%)和肺动脉压增高(60.0%)为主;相对于低抗凝组,高抗凝组的目标INR水平显著增高[(2.94±0.33)vs(1.95±0.33),P<0.001],同时,调整后的华法林用量[(1.61±0.51)vs(2.33±0.54)mg,P<0.001]显著降低,且中途停药调整率显著增加(52.2%vs 12.8%,P<0.001),而临床疗效、出血事件及消化道症状等方面均无显著差异(P>0.05)。结论对于老年肺栓塞患者的维持治疗,相对于高抗凝治疗方案,低抗凝治疗能达到同样有效的疗效,且能显著降低维持治疗过程中需中途调整华法林剂量的比率。更多还原

【Abstract】 Objective To explore efficacy and therapeutic effect of different anticoagulant regimens in the elderly patients with pulmonary embolism. Methods A total of 70 consecutive elderly patients with pulmonary embolism admitted in our hospital from January 2010 to July 2015 were enrolled in the study. All of them received anticoagulation therapy with warfarin and low molecular weight heparin. According to whether obtaining the target value of international normalized ratio( INR),they were divided into highanticoagulation group( n = 23,INR > 2. 5) and low-anticoagulation group( n = 47,INR ≤2. 5). The warfarin dose adjustment,anticoagulation efficacy and therapeutic effects were compared between the 2 groups. The data were analyzed with SPSS statistics 19. 0.Continuous data were expressed as mean ± standard deviation after checking for normality of distribution,and Student’s t test was used for group comparison. The data not normally distributed were expressed with median and interquartile range,and intergroup comparison was conducted by Mann-Whitney U test. Enumeration data were expressed as percentage,and intergroup comparison was carried out with Chi-square test or Fisher exact test. Results Dyspnea( 68. 6%) and pulmonary hypertension( 60. 0%) were the main manifestations in the 70 patients. Compared with the low-anticoagulation group,the high-anticoagulation group had significantly increased target value of INR level [( 2. 94 ± 0. 33) vs( 1. 95 ± 0. 33),P < 0. 001 ],obviously decreased dosage of warfarin after adjustment[( 1. 61 ± 0. 51) vs( 2. 33 ± 0. 54) mg,P < 0. 001],and more common discontinuation and dose adjustment of warfarin( 52. 2% vs12. 8%,P < 0. 001). Meanwhile,there was no significant difference in clinical efficacy and incidences of bleeding events and gastrointestinal symptoms between the 2 groups( P > 0. 05). Conclusion For maintenance of anticoagulation therapy in the elderly with pulmonary embolism,low-anticoagulation regimen shows similar clinical efficacy as high dose,and it also can significantly decrease the incidence of discontinuation and dose adjustment of warfarin during the process.更多还原