中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2010年
1期
10-12
,共3页
耿清峰%李梅茹%李红月%王斌%安树章%成丽娟%齐建立%刘玉惠%杨永利%常顺
耿清峰%李梅茹%李紅月%王斌%安樹章%成麗娟%齊建立%劉玉惠%楊永利%常順
경청봉%리매여%리홍월%왕빈%안수장%성려연%제건립%류옥혜%양영리%상순
心房颤动%非瓣膜性%血栓栓塞%华法林%阿司匹林%双嘧达莫
心房顫動%非瓣膜性%血栓栓塞%華法林%阿司匹林%雙嘧達莫
심방전동%비판막성%혈전전새%화법림%아사필림%쌍밀체막
Atrial fibrillation,nonvalvular%Thromboembolism%Warfarin%Aspirin%Dipyridamole
目的 比较阿司匹林联合双嘧达莫与华法林预防高危非瓣膜性心房颤动(NVAF)患者血栓栓塞的有效性和安全性.方法 将确诊的140例高危NVAF患者,采用机械抽样法随机分为两组,分别给予调整剂量华法林抗凝治疗[华法林组78例,目标国际标准化比值(INR)为2.0～3.0,年龄>75岁者INR为1.6～2.5]和阿司匹林联合双嘧达莫治疗(联合治疗组62例,阿司匹林100mg1次/d+双嘧达莫100 mg 3次/d).观察两组患者死亡、血栓栓塞事件(缺血性脑卒中和周围动脉栓塞)及各种出血的发生率.结果 随访12～28个月.华法林组失访3例,发生缺血性脑卒中2例,严重出血2例,轻微出血6例;联合治疗组失访2例,发生缺血性脑卒中6例,周围动脉栓塞2例,轻微出血3例,无严重出血病例.华法林组血栓栓塞事件的发生率明显低于联合治疗组[2.7%(2/75)比13.3%(8/60),P<0.05];出血发生率高于联合治疗组,但差异无统计学意义[10.7%(8/75)比5.0%(3/60),P>0.05].结论 华法林抗凝治疗预防高危NVAF患者血栓栓塞事件的疗效优于阿司匹林联合双嘧达莫抗血小板治疗,当INR>3.0时出血发生率明显增加,严密监测下(INR 2.0～3.0)调整剂量华法林抗凝治疗安全有效.
目的 比較阿司匹林聯閤雙嘧達莫與華法林預防高危非瓣膜性心房顫動(NVAF)患者血栓栓塞的有效性和安全性.方法 將確診的140例高危NVAF患者,採用機械抽樣法隨機分為兩組,分彆給予調整劑量華法林抗凝治療[華法林組78例,目標國際標準化比值(INR)為2.0～3.0,年齡>75歲者INR為1.6～2.5]和阿司匹林聯閤雙嘧達莫治療(聯閤治療組62例,阿司匹林100mg1次/d+雙嘧達莫100 mg 3次/d).觀察兩組患者死亡、血栓栓塞事件(缺血性腦卒中和週圍動脈栓塞)及各種齣血的髮生率.結果 隨訪12～28箇月.華法林組失訪3例,髮生缺血性腦卒中2例,嚴重齣血2例,輕微齣血6例;聯閤治療組失訪2例,髮生缺血性腦卒中6例,週圍動脈栓塞2例,輕微齣血3例,無嚴重齣血病例.華法林組血栓栓塞事件的髮生率明顯低于聯閤治療組[2.7%(2/75)比13.3%(8/60),P<0.05];齣血髮生率高于聯閤治療組,但差異無統計學意義[10.7%(8/75)比5.0%(3/60),P>0.05].結論 華法林抗凝治療預防高危NVAF患者血栓栓塞事件的療效優于阿司匹林聯閤雙嘧達莫抗血小闆治療,噹INR>3.0時齣血髮生率明顯增加,嚴密鑑測下(INR 2.0～3.0)調整劑量華法林抗凝治療安全有效.
목적 비교아사필림연합쌍밀체막여화법림예방고위비판막성심방전동(NVAF)환자혈전전새적유효성화안전성.방법 장학진적140례고위NVAF환자,채용궤계추양법수궤분위량조,분별급여조정제량화법림항응치료[화법림조78례,목표국제표준화비치(INR)위2.0～3.0,년령>75세자INR위1.6～2.5]화아사필림연합쌍밀체막치료(연합치료조62례,아사필림100mg1차/d+쌍밀체막100 mg 3차/d).관찰량조환자사망、혈전전새사건(결혈성뇌졸중화주위동맥전새)급각충출혈적발생솔.결과 수방12～28개월.화법림조실방3례,발생결혈성뇌졸중2례,엄중출혈2례,경미출혈6례;연합치료조실방2례,발생결혈성뇌졸중6례,주위동맥전새2례,경미출혈3례,무엄중출혈병례.화법림조혈전전새사건적발생솔명현저우연합치료조[2.7%(2/75)비13.3%(8/60),P<0.05];출혈발생솔고우연합치료조,단차이무통계학의의[10.7%(8/75)비5.0%(3/60),P>0.05].결론 화법림항응치료예방고위NVAF환자혈전전새사건적료효우우아사필림연합쌍밀체막항혈소판치료,당INR>3.0시출혈발생솔명현증가,엄밀감측하(INR 2.0～3.0)조정제량화법림항응치료안전유효.
Objective To compare the efficiency and safety of aspirin-dipyridamole and warfarin in the prevention of thromboembolism in patients with nonvalvular atrial fibrillation(NVAF)and high risk factors.Methods One hundred and forty NVAF patients with high risk factors were randomly divided into two groups.Warfarin group[78 cases international normalized ratio(INR)2.0-3.0,for the patients older than 75 years,INR ranging from 1.6 to 2.5]and combination group(62 cases received aspirin 160 mg once every day plus dipyridamole 160 mg 3 times every day).The incidence of death,thromboembolism(including stroke and peripheral arteries embolism)and hemorrhage events were observed.Results Followed-up 12-28 months.In warfarin group,3 cases lost,2 cages had stroke,2 cases suffered from serious bleeding events,6 cases had minor bleeding events.In combination group,2 cases lost,6 cases had stroke,and 2 cases suffered from peripheral arteries embolism events,3 cases had minor bleeding events,but no serious bleeding events occurred.The incidence of thromboembolism in warfarin group wag,lower than that in combination group[2.7%(2/75)vs 13.3%(8/60),P<0.05].There was no significant difference of the bleeding rate between the two groups[10.7%(8/75)vs 5.0%(3/60),P>0.05].Conclusions Warfarin anticoagulative therapy is more effective than aspirin and dipyridamole antiplatelet dual therapy for the prevention of thromboembolism events in patients with NVAF and high risk factors.The major bleeding events in warfarin group occurs in patients with INR>3.0,so under intensive monitoring(INR 2.0-3.0),warfarin therapy is effective and safety.
