中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

利伐沙班在急性中危肺血栓栓塞合并下肢深静脉血栓患者治疗中的临床意义

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目的 探讨利伐沙班在急性中危肺血栓栓塞合并下肢深静脉血栓患者治疗中的疗效及安全性。 方法 采用前瞻性随机对照研究的设计方法,收集 2010 年 1 月至 2017 年 3 月在湖南省人民医院住院治疗的 60 例急性中危肺血栓栓塞合并下肢深静脉血栓患者临床资料。依据治疗方式不同分为利伐沙班组和传统华法林组(对照组),各 30 例。在治疗后 10 d、20 d 和 30 d 比较两组的临床疗效及安全性。 结果 CT 肺动脉造影和超声心动图结果表明利伐沙班组右心室最大短轴、左心室最大短轴直径、右心室最大短轴与左心室最大短轴直径比值、肺动脉收缩压和主肺动脉直径值在治疗后 10 d、20 d 及 30 d 与对照组比较无显著差异(均 P>0.05),但两组组内不同时间点间比较,差异均有统计学意义(均P<0.05)。利伐沙班组和对照组氨基末端 B 型脑钠肽在治疗后 10 d、20 d 和 30 d 显著降低,PO2 值在治疗后 10 d、20 d 明显升高,而治疗后 30 d 与 20 d 比较无明显差异。D-二聚体在对照组和利伐沙班组治疗后 10 d 明显增高,利伐沙班组更明显,而在治疗后 20 d、30 d 降低,利伐沙班组下降更显著,且两组及组间比较差异均显著,有统计学意义(均 P<0.05)。 结论 利伐沙班治疗急性中危肺血栓栓塞合并下肢深静脉血栓患者临床疗效明显且安全,值得临床实施与推广应用。

Objective To explore clinical effect and safety of rivaroxaban in treatment of acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs. Methods The clinical data of 60 patients with acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs, collected from January 2010 to March 2017 in Hunan Provincial People’s Hospital, were retrospectively analyzed. According to the different treatment, these patients were randomly divided into a rivaroxaban group and a control group (traditional warfarin anticoagulation), with 30 patients in each group. The clinical effect and safety were compared between two groups on the 10th day, 20th day and 30th day after treatment. Results Compared with the control group, maximum short axis diameter, ratio of right and left ventricles, systolic pulmonary artery pressure, and main pulmonary artery diameter measured by CTPA and echocardiography in the rivaroxaban group were not significantly different on the 10th day, 20th day and 30th day after treatment. However, the intragroup differences were statistically significant at different timepoint (P<0.05). Levels of N-terminal-pro-brain natriuretic peptide of two groups after treatment were significantly reduced on the 10th day, 20th day and 30th day after treatment, and the values of PO2 were significantly increased on the 10th day and 20th day after treatment (P<0.05), but no significant differences were found in the values of PO2 on 20th day and 30th day after treatment. D-dimer in the two groups was obviously increased on the 10th day after treatment but significantly declined on the 20th day and 30th day after treatment (all P<0.05). These changes were predominant in the rivaroxaban group. Conclusion Rivaroxaban is effective and safe for acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs, and worthy of clinical implementation and application.

关键词: 利伐沙班; 肺血栓栓塞; 下肢深静脉血栓; 华法林

Key words: Rivaroxaban; Pulmonary thromboembolism; Deep vein thrombosis of lower limbs; Warfarin

引用本文: 江刚, 张卫东, 彭敏恋. 利伐沙班在急性中危肺血栓栓塞合并下肢深静脉血栓患者治疗中的临床意义. 中国呼吸与危重监护杂志, 2018, 17(2): 172-177. doi: 10.7507/1671-6205.201704018 复制

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1. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest, 2016, 149(2): 315-352.
2. Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC Guidlines on the diagnosis and management of actue pulmonary embolism.Kardio Pol, 2014, 72(11): 997-1053.
3. 中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南. 2012, 50(7): 611-614
4. Büller HR, Prins MH, Lensin AW, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med, 2012, 366 (14): 1287-1297.
5. Beyer WJ, Lensing AW, Arya R, et al. Choosing wisely: the impact of patient selection on efficacy and safety outcomes in the EINSTEIN-DVT/PE and AMPLIFY trials.Thromb Res, 2017, 149: 29-37
6. Weekes AJ, Thacker G, Troha D, et al. Diagnostic accuracy of right ventricular dysfunction markers in normotensive emergency department patients with acute pulmonary embolism. Ann Emerg Med, 2016, 68(3): 277-291.
7. Park JR, Chang SA, Jang SY, et al. Evaluation of right ventricular dysfunction and prediction of clinical outcomes in acute pulmonary embolism by chest computed tomography: comparisons with echocardiography.Int J Cardiovasc Imaging, 2012, 28(4): 979-987.
8. Zhao DJ, Ma DQ, He W, et al. Cardiovascular parameters to assess the severity of acute pulmonary embolism with computed tomography.Acta Radio, 2010, 51(4): 413-419.
9. Jimenez D, Lobo JL, Monreal M, et al. Prognostic significance of multidetector CT in normotensive patients with pulmonary embolism: results of the protect study.Thorax, 2014, 69(2): 109-115.
10. Meinel FG, Nance JW, Schoepf UJ, et al. Predictive value of computed tomography in acute pulmonary embolism: systematic review and Meta-analysis.Am J Med, 2015, 128(7): 747-759.
11. Trujillo-Santos J, den Exter PL, Gómez V, et al. Computed tomography-assessed right ventricular dysfunction and risk stratification of patients with acute non-massive pulmonary embolism: systematic review and meta-analysis.J Thromb Haemost, 2013, 11(10): 1823-1832.
12. Keller K, Beule J, Schulz A, et al. Right ventricular dysfunction in hemodynamically stable patients with actue pulmonary embolism.Thromb Res, 2014, 133(4): 555-559.
13. Kreit JW.The impact of right ventricular dysfunction on the prognosis and therapy of normotensive patients with pulmonary embolism.Chest, 2004, 125: 1539-1545.
14. Cho JH, Kutti Sridharan G, Kim SH. Right ventricular dysfunction as an echocardiographic prognostic factor in hemodynamically stable patients with acute pulmonary embolism: a meta-analysis. BMC Cardiovasc Disord, 2014, doi: 10.1186/1471-2261-14-64.
15. Bing R, Chow V, Lau JK, et al. Prevalence of echocardiography use in patients hospitalized with confirmed acute pulmonary embolism: a real-world observational multicenter study.Plos One, 2016, 11(12): e0168554.
16. Celik Y, Yardan T, Baydin A, et al. The role of NT-proBNP and Apelin in the assessment of right ventricular dysfunction in acute pulmonary embolism.J Pak Med Assoc, 2016, 66(3): 306-311.
17. Lankeit M, Jiménez D, Kostrubiec M, et al. Validation of N-terminal pro-brain natriuretic peptide cut-off values for risk stratification of pulmonary embolism.Eur Respir J, 2014, 43(6): 1669-1677.
18. Bircan A, Karadeniz N, Ozden A, et al. A simple clinical model composed of ECG, shock index, and arterial blood gas analysis for predicting severe pulmonary embolism.Clin Appl Thromb Hemost, 2011;17(2): 188-196.
19. Ince O, Altintas N, Findik S, et al. Risk stratification in submassive pulmonary embolism via alveolar-arterial oxygen gradient.Hippokratia, 2014, 18(4): 333-339.
20. Ozsu S, Abul Y, Yilmaz I, et al. Prognostic significance of PaO2/PaCO2 ratio in normotensive patients with pulmonary embolism.Clin Respir J, 2012, 6(2): 104-111.