银杏达莫注射液联合华法林治疗急性高危肺栓塞的临床研究
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摘要
目的探讨银杏达莫注射液联合华法林治疗急性高危肺栓塞的临床效果。方法选取2015年3月—2018年3月平山县人民医院收治的78例急性高危肺栓塞患者,随机分为对照组(39例)和治疗组(39例)。对照组口服华法林钠片,初始剂量为2.5 mg/d,连用5d后按照国际标准化比值(INR)调整剂量,最佳抗凝目标范围为INR达2.0～3.0。治疗组在对照组的基础上静脉滴注银杏达莫注射液,20 mL溶于生理盐水500 mL,2次/d。两组均连续治疗14 d。观察两组患者临床疗效,同时比较治疗前后两组主要症状缓解情况、血气指标、纤溶系统指标、血小板、右心功能参数变化情况。结果治疗后,治疗组总有效率为92.3%,显著高于对照组的74.4%,两组比较差异具有统计学意义(P<0.05)。治疗后,治疗组主要症状呼吸困难、胸痛、紫绀、低血压和单侧肢体肿胀的缓解时间较对照组均显著缩短,两组比较差异具有统计学意义(P<0.05)。治疗后,两组动脉血氧(p O2)和二氧化碳分压(p CO2)值均显著升高,肺泡–动脉血氧梯度(A-aDO2值)、D-二聚体(D-D)和纤维蛋白原降解产物(FDP)水平、血小板分布宽度(PDW)、平均血小板体积(MPV)、肺动脉收缩压(PASP)、右心室横径(RVTD)和右心房横径(RAd)均显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);且治疗后治疗组这些观察指标明显优于对照组,两组比较差异有统计学意义(P<0.05)。结论银杏达莫注射液联合华法林治疗急性高危肺栓塞疗效显著,能明显减轻患者症状,改善血气状态,调节纤溶功能及血小板功能,增强右心功能,具有一定临床推广应用价值。
Objective To investigate the clinical effect of Ginkgo Leaf Extract Dipyridamole Injection combined with warfarin in treatment of acute high-risk pulmonary embolism. Methods Patients(78 cases) with acute high-risk pulmonary embolism in Pingshan County People's Hospital from March 2015 to March 2018 were divided into control(39 cases) and treatment(39 cases) groups. Patients in the control group were po administered with Warfarin Sodium Tablets with an initial dose of 2.5 mg/d. After continuously used for 5 d, the dosage was adjusted according to the international standard ratio(INR). And the optimal anticoagulation target range was INR with 2.0 — 3.0. Patients in the treatment group were iv administered with Ginkgo Leaf Extract Dipyridamole Injection on the basis of the control group, 20 mL added into 0.9% sodium chloride solution 500 mL, twice daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacy was evaluated, and symptom relief time, blood gas indexes and fibrinolytic system indicators, and platelet and right heart function parameters in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the treatment group was 92.3%, which was significantly higher than 74.4% in the control group, and there were differences between two groups(P < 0.05). After treatment, the remission time of main symptoms including dyspnea, chest pain, cyanosis, hypotension, and swelling in one limbin the treatment group was significantly shorter than those in the control group, and there were differences between two groups(P < 0.05). After treatment, p O2 and p CO2 in two groups were significantly increased, but A-aDO2 value, D-D, FDP, PDW, MPV, PASP, and RVTD were significantly decreased, and the difference was statistically significant in the same group(P < 0.05). And those obvervational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups(P < 0.05). Conclusion Ginkgo Leaf Extract Dipyridamole Injection combined with warfarin has significant clinical efficacy in treatment of acute high-risk pulmonary embolism, and can relieve patient's symptoms, improve blood gas state, regulate fibrinolytic function and platelet function, and enhance the right heart function, which has a certain clinical application value.
Objective To investigate the clinical effect of Ginkgo Leaf Extract Dipyridamole Injection combined with warfarin in treatment of acute high-risk pulmonary embolism. Methods Patients(78 cases) with acute high-risk pulmonary embolism in Pingshan County People's Hospital from March 2015 to March 2018 were divided into control(39 cases) and treatment(39 cases) groups. Patients in the control group were po administered with Warfarin Sodium Tablets with an initial dose of 2.5 mg/d. After continuously used for 5 d, the dosage was adjusted according to the international standard ratio(INR). And the optimal anticoagulation target range was INR with 2.0 — 3.0. Patients in the treatment group were iv administered with Ginkgo Leaf Extract Dipyridamole Injection on the basis of the control group, 20 mL added into 0.9% sodium chloride solution 500 mL, twice daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacy was evaluated, and symptom relief time, blood gas indexes and fibrinolytic system indicators, and platelet and right heart function parameters in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the treatment group was 92.3%, which was significantly higher than 74.4% in the control group, and there were differences between two groups(P < 0.05). After treatment, the remission time of main symptoms including dyspnea, chest pain, cyanosis, hypotension, and swelling in one limbin the treatment group was significantly shorter than those in the control group, and there were differences between two groups(P < 0.05). After treatment, p O2 and p CO2 in two groups were significantly increased, but A-aDO2 value, D-D, FDP, PDW, MPV, PASP, and RVTD were significantly decreased, and the difference was statistically significant in the same group(P < 0.05). And those obvervational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups(P < 0.05). Conclusion Ginkgo Leaf Extract Dipyridamole Injection combined with warfarin has significant clinical efficacy in treatment of acute high-risk pulmonary embolism, and can relieve patient's symptoms, improve blood gas state, regulate fibrinolytic function and platelet function, and enhance the right heart function, which has a certain clinical application value.
引文
[1]谢琼,卢月月,易宏锋.急性肺栓塞92例临床分析[J].现代中西医结合杂志, 2014, 23(33):3684-3685.
[2]米玉红.急性肺血栓栓塞症的诊断与治疗规范及面临的问题[J].中国急救医学, 2017, 37(1):17-22.
[3]冯家钢,戴路明.华法林的药理作用及在肺血栓栓塞中的应用[J].中外医学研究, 2010, 8(29):193-195.
[4]宾驰.银杏达莫注射液的药理作用及临床应用研究进展[J].中国药业, 2010, 19(14):88.
[5]中华医学会心血管病学分会肺血管病学组.急性肺血栓栓塞症诊断治疗中国专家共识[J].中华内科杂志,2010, 49(1):74-81.
[6]孙传兴.临床疾病诊断依据治愈好转标准[M].第2版.北京:人民军医出版社, 2002:55.
[7]金会艳,阮丽波,韩毅,等.急性肺栓塞家兔血流动力学参数及组织病理学改变[J].微循环学杂志,2012,22(3):7-10.
[8]王连馥,王旭东.急性肺栓塞的急诊处理[J].中国临床医生杂志, 2016, 44(2):5-9.
[9]李金玉,程爱斌,施举红.华法林对凝血因子及出凝血时间的影响[J].中华医学杂志,2017,97(42):3347-3349.
[10]周群,侯东彬.银杏达莫注射液的药理作用及不良反应研究进展[J].中国药房, 2013, 24(28):2686-2688.
[11]王宝锋,关敏.注射用降纤酶联合银杏达莫注射液治疗急性次大面积肺栓塞的临床疗效观察[J].实用心脑肺血管病杂志, 2017, 25(8):112-116.
[12]张昱,李文超,杨峰.动脉血气联合D-二聚体在急性肺栓塞诊断中的价值[J].重庆医学, 2013, 42(18):2135-2137.
[13]冯宗莲,秦志强,覃少佳,等.肺栓塞患者凝血纤溶系统指标与CT肺动脉阻塞指数的关系[J].中国急救医学, 2016, 36(11):1001-1005.
[14]陈嵩,张莹,戴月梅,等.急性肺栓塞患者血小板指标的变化及临床意义[J].中国全科医学,2014,17(19):2218-2223.
[15]胡丽艳,郭俏俏,戚小杨,等.超声心动图在肺栓塞患者治疗前后右心功能评估中的价值研究[J].重庆医学, 2017, 46(16):2209-2211.
[2]米玉红.急性肺血栓栓塞症的诊断与治疗规范及面临的问题[J].中国急救医学, 2017, 37(1):17-22.
[3]冯家钢,戴路明.华法林的药理作用及在肺血栓栓塞中的应用[J].中外医学研究, 2010, 8(29):193-195.
[4]宾驰.银杏达莫注射液的药理作用及临床应用研究进展[J].中国药业, 2010, 19(14):88.
[5]中华医学会心血管病学分会肺血管病学组.急性肺血栓栓塞症诊断治疗中国专家共识[J].中华内科杂志,2010, 49(1):74-81.
[6]孙传兴.临床疾病诊断依据治愈好转标准[M].第2版.北京:人民军医出版社, 2002:55.
[7]金会艳,阮丽波,韩毅,等.急性肺栓塞家兔血流动力学参数及组织病理学改变[J].微循环学杂志,2012,22(3):7-10.
[8]王连馥,王旭东.急性肺栓塞的急诊处理[J].中国临床医生杂志, 2016, 44(2):5-9.
[9]李金玉,程爱斌,施举红.华法林对凝血因子及出凝血时间的影响[J].中华医学杂志,2017,97(42):3347-3349.
[10]周群,侯东彬.银杏达莫注射液的药理作用及不良反应研究进展[J].中国药房, 2013, 24(28):2686-2688.
[11]王宝锋,关敏.注射用降纤酶联合银杏达莫注射液治疗急性次大面积肺栓塞的临床疗效观察[J].实用心脑肺血管病杂志, 2017, 25(8):112-116.
[12]张昱,李文超,杨峰.动脉血气联合D-二聚体在急性肺栓塞诊断中的价值[J].重庆医学, 2013, 42(18):2135-2137.
[13]冯宗莲,秦志强,覃少佳,等.肺栓塞患者凝血纤溶系统指标与CT肺动脉阻塞指数的关系[J].中国急救医学, 2016, 36(11):1001-1005.
[14]陈嵩,张莹,戴月梅,等.急性肺栓塞患者血小板指标的变化及临床意义[J].中国全科医学,2014,17(19):2218-2223.
[15]胡丽艳,郭俏俏,戚小杨,等.超声心动图在肺栓塞患者治疗前后右心功能评估中的价值研究[J].重庆医学, 2017, 46(16):2209-2211.