【摘要】 目的 探讨超早期抗凝在急性高危肺栓塞患者中应用的临床效果和安全性。方法 采用回顾性研究的方法，选择2018年9月至2021年11月在广西玉林市中西医结合骨科医院诊治的60例急性高危肺栓塞患者为观察组，同期在玉林市其他三级综合医院诊治的急性高危肺栓塞患者60例为对照组。对照组患者经确诊为急性高危肺栓塞后进行抗凝联合溶栓治疗，观察组患者在拟诊为急性高危肺栓塞时立即进行超早期多靶点抗凝治疗，经确诊后继续进行抗凝联合溶栓治疗。比较两组患者治疗前后动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）、动脉血氧饱和度（SaO₂）、血浆D-二聚体水平、血浆活化部分凝血活酶时间（APTT）水平，以及临床疗效和不良反应发生情况。结果 治疗前，两组患者的PaO₂、PaCO₂、SaO₂差异均无统计学意义（均P>0.05）;治疗24 h后，观察组患者的PaO₂、SaO₂水平均高于对照组，PaCO₂水平低于对照组（均P<0.05）。治疗前，两组患者的血浆D-二聚体、APTT水平差异均无统计学意义（均P>0.05）;治疗2周后，观察组患者的血浆D-二聚体、APTT水平均低于对照组（均P<0.05）。治疗2周后，观察组患者的治疗总有效率为91.67%,高于对照组的76.67%（P<0.05）。住院治疗期间，两组患者的不良反应发生率差异无统计学意义（P>0.05）。结论 急性高危肺栓塞患者实施超早期抗凝治疗能够改善患者呼吸功能和凝血纤溶系统功能，提高治疗效果，且安全性较高。更多还原

【Abstract】 Objective To investigate the clinical effect and safety of ultra-early anticoagulation in patients with acute high-risk pulmonary embolism. Methods The retrospective study method was conducted, 60 patients with acute high-risk pulmonary embolism who were diagnosed and treated in Guangxi Yulin Orthopedic Hospital of Integrated Traditional Chinese and Western Medicine from September 2018 to November 2021 were selected as the observation group, and 60 patients with acute high-risk pulmonary embolism who were treated in other tertiary general hospitals in Yulin City during the same period were selected as the control group. The patients in the control group received anticoagulation combined with thrombolysis therapy after being diagnosed with acute high-risk pulmonary embolism, while the patients in the observation group received ultra-early multi-target anticoagulation therapy immediately after being suspected of acute high-risk pulmonary embolism, and continued to receive anticoagulation combined with thrombolysis therapy after being diagnosed. The levels of arterial partial pressure of oxygen（PaO₂）, arterial partial pressure of carbon dioxide（PaCO₂）, arterial oxygen saturation（SaO₂）, plasma D-dimer level, and plasma activated partial thromboplastin time（APTT） level before and after the treatment, as well as clinical efficacy and incidence of adverse reactions, were compared between the two groups. Results Before the treatment, there was no significant difference in PaO₂, PaCO₂ or SaO₂ between the two groups（all P>0.05）, and after the 24-hour treatment, the levels of PaO₂ and SaO₂ in the observation group were higher than those in the control group, while the level of PaCO₂ was lower than that in the control group（all P<0.05）. Before the treatment, there was no statistically significant difference in the plasma D-dimer or APTT level between the two groups（all P>0.05）, and after the 2-week treatment, the plasma levels of D-dimer and APTT in the observation group were lower than those in the control group（all P<0.05）. After the 2-week treatment, the total therapeutic effective rate of patients in the observation group was 91.67%, which was higher than that in the control group（76.67%）（P<0.05）. There was no statistically significant difference in the incidence of adverse reactions between the two groups during the hospitalization（P>0.05）. Conclusion Ultra-early anticoagulation therapy can improve the respiratory function, coagulation and fibrinolytic system function of patients with acute high-risk pulmonary embolism, and improve the therapeutic effect, which has high safety value.更多还原