摘要
目的:观察利伐沙班治疗急性肺栓塞的疗效及其对患者血气指标和肺功能的影响。方法:选择2017年12月至2019年6月衢州市人民医院收治的急性肺动脉栓塞患者92例,采用随机数字表法分为对照组(n=46)和观察组(n=46),对照组口服华法林,观察组口服利伐沙班治疗,比较两组患者治疗有效率、治疗前后血气指标与肺功能变化以及不良反应发生情况。结果:观察组总有效率(97.8%,45/46)高于对照组(80.4%,37/46),差异有统计学意义(χ^(2)=7.180,P<0.05);两组患者治疗后第1秒用力呼气容积(FEV 1)及其占预计值百分比(FEV 1%)、占用力肺活量比值(FEV 1/FVC)、每分钟最大通气量占预计值百分比(MVV%)均不同程度升高[观察组FEV 1、FEV 1%、FEV 1/FVC、MVV%治疗前分别为(1.20±0.19)L、(54.66±9.39)%、(59.04±8.55)%、(54.54±9.33)%;治疗后分别为(1.82±0.29)L、(70.12±12.49)%、(78.7±10.42)%、(76.55±11.25)%,t=-11.262、-7.090、-8.165、-14.803,均P<0.01;对照组治疗前FEV 1、FEV 1%、FEV 1/FVC、MVV%分别为(1.22±0.15)L、(52.98±8.77)%、(61.17±9.44)%、(53.36±9.45)%;治疗后分别为(1.45±0.36)L、(60.05±10.38)%、(72.11±8.52)%、(64.11±10.46)%,t=4.518、-3.153、-6.440、-5.157,均P<0.01],且观察组治疗后高于对照组(t=-5.395、-4.205、-3.406、-5.822,均P<0.05);两组血氧饱和度(SpO 2)、动脉血氧分压(PaO 2)治疗后均较治疗前升高[观察组治疗前分别为(78.37±8.55)mmHg、(7.28±9.06)mmHg,治疗后分别为(91.61±8.13)mmHg、(87.6±13.62)mmHg,对照组治疗前分别为(76.65±7.06)mmHg、(68.01±9.72)mmHg,治疗后(85.91±8.22)mmHg、(2.38±9.65)mmHg],而PaCO 2较治疗前降低[观察组治疗前后分别为(72.30±6.23)mmHg比(51.8±8.33)mmHg,t=-9.031,P<0.05;对照组治疗前后分别为(73.11±7.90)mmHg比(63.09±6.49)mmHg,t=11.450,P<0.05],且观察组改善程度明显优于对照组(t=-3.342、-8.549、5.848,均P<0.05);两组血浆D-二聚体治疗前后差异有统计学意义[观察组治疗前后分别为(2.49±0.44)mg/L,(1.62±0.33)mg/L,t=10.237,P<0.05;对照组治疗前后分别为(2.48±0.43)mg/L,(1.96±0.38)mg/L,t=5.264,P<0.05,观察组治疗后显著低于对照组(t=4.538,P<0.05)。观察组、对照组不良反应发生率分别为21.7%(11/46)、19.6%(9/46),差异无统计学意义(P>0.05)。结论:口服利伐沙班可明显改善急性肺栓塞患者的血气指标和肺功能,安全可靠。
Objective To investigate the efficacy of rivaroxaban in the treatment of acute pulmonary embolism and its effect on blood gas index and pulmonary function.Methods A total of 92 patients with acute pulmonary embolism who received treatment in Quzhou People's Hospital from December 2017 to June 2019 were included in this study.They were randomly assigned to receive oral warfarin(n=46,control group)or oral rivaroxaban(n=46,observation group).After treatment,therapeutic efficacy,changes in blood gas index and pulmonary function,and the incidence of adverse reactions were compared between the observation and control groups.Results Total effective rate in the observation group was significantly higher than that in the control group[97.8%(45/46)vs.80.4%(37/46);χ^(2)=7.180,P<0.05].In each group,forced expiratory volume in 1 second(FEV1),percentage of predicted FEV1(FEV1%),FEV1/forced vital capacity ratio(FEV1/FVC),and percentage of predicted maximal voluntary ventilation in 1 second(MVV%)after treatment were significantly increased compared with before treatment[in the observation group,FEV1,FEV1%,FEV1/FVC,MVV%were(1.20±0.19)L,(54.66±9.39)%,(59.04±8.55)%,(54.54±9.33)%,respectively before treatment,while they were(1.82±0.29)L,(70.12±12.49)%,(78.7±10.42)%,(76.55±11.25)%,respectively after treatment,t=-11.262,-7.090,-8.165,-14.803,all P<0.01;in the control group,FEV1,FEV1%,FEV1/FVC,MVV%were(1.22±0.15)L,(52.98±8.77)%,(61.17±9.44)%,(53.36±9.45)%,respectively before treatment,while they were(1.45±0.36)L,(60.05±10.38)%,(72.11±8.52)%,(64.11±10.46)%,respectively after treatment,t=4.518,-3.153,-6.440,-5.157,all P<0.01].FEV1,FEV1%,FEV1/FVC,MVV%in the observation group were significantly higher than those in the control group(t=-5.395,-4.205,-3.406,-5.822,all P<0.05).After treatment,pulse oxygen saturation(SpO2)and arterial oxygen partial pressure(PaO2)were significantly increased compared with before treatment in each group[in the observation group,SpO2 and PaO2 before treatment were(78.37±8.55)mmHg and(7.28±9.06)mmHg,respectively and they were(91.61±8.13)mmHg and(87.6±13.62)mmHg,respectively after treatment;in the control group,SpO2 and PaO2 before treatment were(76.65±7.06)mmHg and(68.01±9.72)mmHg,respectively,and they were(85.91±8.22)mmHg and(2.38±9.65)mmHg,respectively after treatment.In the observation group,arterial partial pressure of carbon dioxide(PaCO2)after treatment[(51.8±8.33)mmHg]was significantly decreased compared with before treatment[(72.30±6.23)mmHg,t=-9.031,P<0.05].In the control group,PaCO2 after treatment(63.09±6.49)mmHg was significantly decreased compared with before treatment[(73.11±7.90)mmHg,t=11.450,P<0.05].After treatment,the degrees of changes in SpO2,PaO2,PaCO2 in the observation group were greater compared with the control group(t=-3.342,-8.549,5.848,all P<0.05).In the observation group,plasma D-dimer level after treatment was significantly lower than that before treatment[(1.62±0.33)mg/L vs.(2.49±0.44)mg/L,t=10.237,P<0.05).In the control group,plasma D-dimer level after treatment was significantly lower than that before treatment[(1.96±0.38)mg/L vs.(2.48±0.43)mg/L,t=5.264,P<0.05).After treatment,plasma D-dimer level in the observation group was significantly lower than that in the control group(t=4.538,P<0.05).The incidence of adverse reactions was 21.7%(11/46)and 19.6%(9/46)in the observation and control groups,respectively,and there was no significant difference between the two groups(P>0.05).Conclusion Oral rivaroxaban can obviously improve the blood gas index and pulmonary function in patients with acute pulmonary embolism,which is safe and reliable.
作者
吴佳文
陆炜
廖圣
程国兵
胡强
Wu Jiawen;Lu Wei;Liao Sheng;Cheng Guobing;Hu Qiang(Department of Vascular Surgery,Quzhou People's Hospital,Quzhou 324000,Zhejiang Province,China)
出处
《中国基层医药》
CAS
2021年第1期66-70,共5页
Chinese Journal of Primary Medicine and Pharmacy
关键词
肺栓塞
呼吸功能试验
血气分析
利伐沙班
华法林
Pulmonary embolism
Respiratory function tests
Blood gas analysis
Rivaroxaban
Warfarin
