低分子肝素治疗癌症相关性急性肺血栓栓塞症的临床观察

摘要

OBJECTIVE:To observe the clinical efficacy and safety of low molecular heparin in the treatment of cancer-associ-ated acute pulmonary thromboembolism(APTE). METHODS:42 patients with cancer-associated APTE were randomly divided into combination group and simple drug group. All patients were given anti-cancer conventional treatment. Based on it,simple drug group was treated with Low molecular heparin injection 0.1 ml/kg by subcutaneous injection after embolism,q12 h;based on the treatment in simple drug group,combination group was additionally treated with Warfarin sodium tablet initial dose was 3 mg after 1-3 d of treatment,orally,qd. The dosage of warfarin was adjusted based on the international normalized ratio(INR),when INR was 2-3 for continuous 2 days,low molecular heparin was stopped,only warfarin was orally gave. The treatment course was 3 months. The clinic data was observed,including clinical efficacy,and pulmonary arterial blood gas indexes [blood oxygen pressure (pO2)and blood carbon dioxide partial pressure(pCO2)] before and after treatment. The fatality rate,re-embolism rate and bleed-ing rate in 6 months were followed-up,and the incidence of adverse reactions was recorded. RESULTS:The total effective rate in simple drug group was significantly higher than combination group,re-embolism and fatality rate were significantly lower than com-bination group,the differences were statistically significant(P0.05). CONCLU-SIONS:Based on conventional treatment,the low molecular heparin has better efficacy than sequential therapy in the treatment of APTE,with similar safety.%目的：观察低分子肝素治疗癌症相关性急性肺血栓栓塞症（APTE）的临床疗效和安全性。方法：42例癌症相关性APTE患者随机均分为联合组和单药组。两组患者均予以常规抗癌治疗。在此基础上，单药组患者于确诊为APTE后给予低分子肝素钠注射液0.1 ml/kg，皮下注射，q12 h；联合组患者在单药组治疗的基础上于治疗后的1～3 d加服华法林钠片，初始剂量3 mg，口服，qd，并根据国际标准化比值（INR）调整华法林钠的用量，若连续2 d INR为2～3，则停用低分子肝素，仅口服华法林。两组患者疗程均为3个月。观察两组患者的临床疗效，治疗前后肺动脉血气指标[血氧分压（pO2）、血二氧化碳分压（pCO2）]，随访治疗6个月后两组患者的病死率、再栓塞率和出血率并记录不良反应发生情况。结果：单药组患者总有效率显著高于联合组，再栓塞率、病死率均显著低于联合组，差异均有统计学意义（P＜0.05）。治疗后，两组患者肺动脉血气指标均显著高于同组治疗前，单药组高于联合组，差异均有统计学意义（P＜0.05）。两组患者的出血率、不良反应发生率比较，差异均无统计学意义（P＞0.05）。结论：在常规治疗的基础上，低分子肝素治疗癌症相关性APTE的疗效显著优于低分子肝素联合华法林，且安全性相当。