抗凝治疗对急性肺栓塞患者心电图图谱和凝血功能的影响
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摘要
目的探讨急性肺栓塞抗凝治疗前后心电图及凝血功能变化。方法选取2015年1月至2018年5月在我院治疗的急性肺栓塞患者42例,所有患者均给予抗凝治疗,治疗前后采用常规12导联同步心电图进行检查,同时检测D-二聚体(D-D)、蛋白S(PS)、蛋白C(PC)等水平。结果治疗后3个月患者胸前导联T波倒置加深、aVR导联ST段抬高、窦性心动过速、顺钟向转位和V4-V6导联ST段压低比例分别为23.81%、4.76%、9.52%、11.90%和4.76%,明显低于治疗前(P<0.05);治疗后3个月D-D、PS和PC分别为(0.76±0.22)mg/L、(15.03±7.11)mg/L和(2.66±0.81)mg/L,明显低于治疗前,差异比较有统计学意义(P<0.05);治疗后3个月组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制物-1(PAI-1)和凝血酶调节蛋白(TM)分别为(4.41±1.03)g/L、(57.84±10.24)g/L和(3.26±0.97)g/L,明显低于治疗前,差异比较有统计学意义(P<0.05)。结论抗凝治疗急性肺栓塞能有效改善患者心电图异常、凝血纤溶及血管内皮功能。
Objective To investigate the changes of electrocardiogram and coagulation function before and after anticoagulant therapy in acute pulmonary embolism. Methods 42 patients with acute pulmonary embolism treated in our hospital from January 2015 to May 2018 were selected. All patients were given anticoagulant therapy, and routine 12 lead synchronous electrocardiogram(ECG) was performed before and after treatment. At the same time, D-dimer(D-D), protein S(PS) and protein C(PC) levels were detected. Results The ratio of T wave inversion in precordial lead, ST segment elevation of aVR lead, sinus tachycardia, clockwise transposition and ST segment depression in V4-V6 lead at 3 months after treatment were 23.81%, 4.76%, 9.52%, 11.90% and 4.76%, which were significantly lower than those before treatment(P<0.05). 3 months after treatment, D-D, PS and PC were(0. 76 ± 0. 22) mg/L,(15. 03 ± 7. 11) mg/L and(2. 66 ± 0. 81) mg/L,which were significantly lower than those before treatment( P < 0. 05). 3 months after treatment,the tissue plasminogen activator( t-PA),plasminogen activator inhibitor-1( PAI-1) and thrombomodulin( TM) were(4. 41 ± 1. 03) g/L,(57. 84 ± 10. 24) g/L and(3. 26± 0. 97) g/L,which were significantly lower than those before treatment( P < 0. 05). Conclusion Anticoagulant therapy for acute pulmonary embolism can effectively improve electrocardiographic abnormalities,coagulation,fibrinolysis and endothelial function.
Objective To investigate the changes of electrocardiogram and coagulation function before and after anticoagulant therapy in acute pulmonary embolism. Methods 42 patients with acute pulmonary embolism treated in our hospital from January 2015 to May 2018 were selected. All patients were given anticoagulant therapy, and routine 12 lead synchronous electrocardiogram(ECG) was performed before and after treatment. At the same time, D-dimer(D-D), protein S(PS) and protein C(PC) levels were detected. Results The ratio of T wave inversion in precordial lead, ST segment elevation of aVR lead, sinus tachycardia, clockwise transposition and ST segment depression in V4-V6 lead at 3 months after treatment were 23.81%, 4.76%, 9.52%, 11.90% and 4.76%, which were significantly lower than those before treatment(P<0.05). 3 months after treatment, D-D, PS and PC were(0. 76 ± 0. 22) mg/L,(15. 03 ± 7. 11) mg/L and(2. 66 ± 0. 81) mg/L,which were significantly lower than those before treatment( P < 0. 05). 3 months after treatment,the tissue plasminogen activator( t-PA),plasminogen activator inhibitor-1( PAI-1) and thrombomodulin( TM) were(4. 41 ± 1. 03) g/L,(57. 84 ± 10. 24) g/L and(3. 26± 0. 97) g/L,which were significantly lower than those before treatment( P < 0. 05). Conclusion Anticoagulant therapy for acute pulmonary embolism can effectively improve electrocardiographic abnormalities,coagulation,fibrinolysis and endothelial function.
引文
[1] 陈冬丽,谢召峰,汪显祺.阿替普酶溶栓后序贯低分子肝素治疗老年急性次大面积肺栓塞[J].临床误诊误治,2017,30(6):70-74.
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[10] 范建新,李红建.低剂量阿替普酶与尿激酶治疗急性肺栓塞的疗效对比[J].国际呼吸杂志,2016,36(14):1080-1083.
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[12] 王光权,李翠.利伐沙班用于肺栓塞抗凝治疗的临床疗效及其对血管内皮功能的影响[J].安徽医药,2017,21(2):349-352.
[13] MATSUZAKI S,YOSHINO K,ENDO M,et al.Successful anticoagulant therapy for disseminated intravascular coagulation during conservative management of placenta percreta:a case report and literature review[J].BMC Pregnancy Childbirth,2017,17:443.
[14] 叶宝华.参附注射液联合溶栓及抗凝治疗在急性肺栓塞合并低血压患者中的应用观察[J].中国中医急症,2016,25(12):2358-2361.
[15] KAASENBROOD F,HOLLANDER M,RUTTEN F H,et al.Yield of screening for atrial fibrillation in primary care with a hand-held,single-lead electrocardiogram device during influenza vaccination[J].Europace,2016,18(10):1514-1520.
[2] KUDO D,HAYAKAWA M,ONO K,et al.Impact of non-anticoagulant therapy on patients with sepsis-induced disseminated intravascular coagulation:a multicenter,case-control study[J].Thromb Res,2018,163:22-29.
[3] 陈丽秀.低分子肝素联合华法林单纯抗凝治疗急性次大面积肺栓塞的临床效果和安全性观察[J].中国药物警戒,2016,13(11):651-654,659.
[4] 陈元娜,陈梦嘉,马卫成,等.肺栓塞患者服用华法林过程中INR不达标的药学监护[J].中国药物应用与监测,2017,14(4):218-220.
[5] K?RAT T,K?SE N,ALTUN ?,et al.What is the role of routine ECG screening in stable coronary heart disease and effects of oral anticoagulant,antiarrhythmics in these patients with atrial fibrillation?[J].Int J Cardiol,2016,207:140.
[6] 王爱丽,王金祥,李晓辉,等.中高危急性肺血栓栓塞症患者溶栓联合抗凝与单纯抗凝治疗的近期疗效比较[J].心肺血管病杂志,2016,35(7):524-528.
[7] 刘艳,薛晓轩,杨玲,等.急性肺栓塞合并慢性阻塞性肺疾病患者不同治疗方式前后右心功能的变化[J].河北医药,2017,39(10):1527-1529.
[8] LIAO L,SHI B Z,CHANG H,et al.Heparin improves BMSC cell therapy:anticoagulant treatment by heparin improves the safety and therapeutic effect of bone marrow-derived mesenchymal stem cell cytotherapy[J].Theranostics,2017,7(1):106-116.
[9] THEAN D,ALBERGHINI M.Anticoagulant therapy and its impact on dental patients:a review[J].Aust Dent J,2016,61(2):149-156.
[10] 范建新,李红建.低剂量阿替普酶与尿激酶治疗急性肺栓塞的疗效对比[J].国际呼吸杂志,2016,36(14):1080-1083.
[11] GONZáLEZ BáRCENAS M L,PéREZ AISA á.Management of antiplatelet and anticoagulant therapy for endoscopic procedures:introduction to novel oral anticoagulants[J].Rev Esp Enferm Dig,2016,108(2):89-96.
[12] 王光权,李翠.利伐沙班用于肺栓塞抗凝治疗的临床疗效及其对血管内皮功能的影响[J].安徽医药,2017,21(2):349-352.
[13] MATSUZAKI S,YOSHINO K,ENDO M,et al.Successful anticoagulant therapy for disseminated intravascular coagulation during conservative management of placenta percreta:a case report and literature review[J].BMC Pregnancy Childbirth,2017,17:443.
[14] 叶宝华.参附注射液联合溶栓及抗凝治疗在急性肺栓塞合并低血压患者中的应用观察[J].中国中医急症,2016,25(12):2358-2361.
[15] KAASENBROOD F,HOLLANDER M,RUTTEN F H,et al.Yield of screening for atrial fibrillation in primary care with a hand-held,single-lead electrocardiogram device during influenza vaccination[J].Europace,2016,18(10):1514-1520.