目的 探討華法林聯(lián)合低分子肝素治療晚期肺癌急性非大面積肺栓塞的療效觀察。方法 選擇2010年1月-2014年9月天津市第一中心醫(yī)院急診科收治的晚期肺癌急性非大面積肺栓塞患者380例,隨機(jī)分為治療組和對(duì)照組,每組各190例。對(duì)照組皮下注射低分子量肝素鈉注射液,5 000 U/次,2次/d,連續(xù)2 d測(cè)定國(guó)際標(biāo)準(zhǔn)化比率(INR)或凝血酶原時(shí)間(PT)延長(zhǎng)至正常值的1.5~2.5倍時(shí)停用。治療組在對(duì)照組治療基礎(chǔ)上口服華法林鈉片,5 mg/d,1次/d。兩組均連續(xù)治療2周。觀察兩組臨床療效,同時(shí)比較治療前后兩組血氧分壓(pO₂)、二氧化碳分壓(pCO₂)、血氧飽和度(SaO₂)、肺動(dòng)脈壓力、呼吸癥狀評(píng)分、卡氏(KPS)評(píng)分的變化情況。結(jié)果 治療后,對(duì)照組和治療組的總有效率分別為68.95%、78.42%,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療后,兩組pO₂、SaO₂、KPS評(píng)分均顯著升高,pCO₂、肺動(dòng)脈壓力、呼吸癥狀評(píng)分均顯著降低,同組治療前后差異有統(tǒng)計(jì)學(xué)意義(P<0.05);且治療組這些觀察指標(biāo)的改善程度優(yōu)于對(duì)照組,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論 華法林聯(lián)合低分子肝素治療晚期肺癌合并急性非大面積肺栓塞具有較好的臨床療效,能夠顯著改善患者的呼吸癥狀,緩解患者呼吸困難,具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To explore the clinical effect of warfarin combined with low-molecular-weight heparin in treatment of advanced lung cancer with acute massive pulmonary embolism.Methods Patients (380 cases) with advanced lung cancer with acute massive pulmonary embolism in Department of Emergency in Tianjin First Center Hospital from January 2010 to September 2014 were randomly divided into control and treatment groups. Each group had 190 cases. The patients in the control group were sc administered with Low-Molecular-Weight Heparin Sodium Injection, 5 000 U/time, twice daily. International standardization ratio (INR) or PT were measured for 2 d, Low-Molecular-Weight Heparin Sodium Injection was stopped until INR and PT extended to 1.5-2.5 times the normal levels. The patients in the treatment group were po administered with Warfarin Sodium Tablets, 5 mg/d, once daily. The patients in two groups were treated for two weeks. After treatment, the efficacy was evaluated, and the changes of pO₂, pCO₂, SaO₂, pulmonary artery pressure, and respiratory symptom scores in two groups were compared.Results After treatment, the efficacies in the control and treatment groups were 68.95% and 78.42%, respectively, and there were differences between two groups (P < 0.05). After treatment, pO₂, SaO₂, and KPS scores in two groups were significantly increased, and pCO₂, pulmonary artery pressure, and respiratory symptom scores was significantly decreased, and the difference was statistically significant in the same group (P < 0.05). After treatment, the observational indexes in the treatment group were significantly better than those in the control group, withsignificant difference between two groups (P < 0.05).Conclusion Warfarin combined with low-molecular-weight heparin has clinical curative effect in treatment of advanced lung cancer with acute massive pulmonary embolism, and can significantly improve the respiratory symptoms, also can alleviate breathing difficulties, which has a certain clinical application value.

天津市衛(wèi)生局科技基金資助項(xiàng)目(2013KY06)