CAJ | 학술논문

目的：探讨非瓣膜病房颤初始治疗最佳给药方案。方法选取165例非瓣膜病房颤患者作为研究对象，所有患者随机分为联合治疗组、3mg治疗组及5mg治疗组，每组55例，联合治疗组患者给予3mg华法林联合低分子肝素钙5000U皮下注射q12h×4d作为初始治疗；3mg治疗组患者给予华法林3mg作为初始治疗；5mg治疗组患者给予华法林5mg作为初始治疗，根据INR调整华法林剂量，直至INR稳定在2.0～3.0。比较各组患者INR增高发生率及并发症情况。结果联合治疗组INR达到稳定所需时间为（11.8±4.8）d，INR增高次数发生率为5.5%，未出现血及血栓栓塞事件；3mg治疗组INR达到稳定所需时间为（12.5±4.3）d，INR增高发生率为9.1%，未出现主要出血事件，轻微出血发生率为3.6%，血栓栓塞发生率为1.8%；5mg治疗组INR达到稳定所需时间为（17.4±5.3）d，INR增高发生率为16.4%，未出现主要出血事件，轻微出血发生率为9.1%，血栓栓塞发生率为3.6%。结论华法林3mg联用皮下注射低分子肝素钙5000Uq12h×4d作为初始抗凝治疗能使INR迅速安全有效达到稳定，无严重出血并发症，对临床治疗方案的制定具有指导意义。
목적：탐토비판막병방전초시치료최가급약방안。방법선취165례비판막병방전환자작위연구대상，소유환자수궤분위연합치료조、3mg치료조급5mg치료조，매조55례，연합치료조환자급여3mg화법림연합저분자간소개5000U피하주사q12h×4d작위초시치료；3mg치료조환자급여화법림3mg작위초시치료；5mg치료조환자급여화법림5mg작위초시치료，근거INR조정화법림제량，직지INR은정재2.0～3.0。비교각조환자INR증고발생솔급병발증정황。결과연합치료조INR체도은정소수시간위（11.8±4.8）d，INR증고차수발생솔위5.5%，미출현혈급혈전전새사건；3mg치료조INR체도은정소수시간위（12.5±4.3）d，INR증고발생솔위9.1%，미출현주요출혈사건，경미출혈발생솔위3.6%，혈전전새발생솔위1.8%；5mg치료조INR체도은정소수시간위（17.4±5.3）d，INR증고발생솔위16.4%，미출현주요출혈사건，경미출혈발생솔위9.1%，혈전전새발생솔위3.6%。결론화법림3mg련용피하주사저분자간소개5000Uq12h×4d작위초시항응치료능사INR신속안전유효체도은정，무엄중출혈병발증，대림상치료방안적제정구유지도의의。
Objective To investigate warfarin optimal dosage regimen of initial treatment of non-valvular atrial fibrillation. Methods Take 165 patients with non-valvular atrial fibrillation patients of our hospital as research objects, all the patients were randomly divided into combined treatment group, 3 mg treatment group and 5 mg treatment group, 55 cases each group. The combined treatment groups were given 3 mg warfarin combined with subcutaneous injection of 5000 units low molecular weight heparin as initial treatment. 3 mg treatment groups were treated with warfarin 3 mg as initial therapy. 5 mg treatment groups were treated with warfarin 5 mg as initial therapy. It was until the INR was stable in 2-3 according to the INR to adjust the dosage of warfarin. Compared the incidence of INR increase and complications. Results Combined treatment group:INR required to achieve stable time was 11.8 ± 4.8 d, the occurrence rate of INR increase was 5.5%and there was no bleeding and thromboembolic events. 3 mg treatment group:INR required to achieve stable time was (12.5 ± 4.3)d, the occurrence rate of INR increase was 9.1%, there was no Major bleeding events, the occurrence rate of bleeding was 3.6%, and the occurrence rate of thrombo-embolia was 1.8%. 5 mg treatment group:INR required to achieve stable time was (17.4 ±5.3) d, the occurrence rate of INR increase was 16.4%, there was no Major bleeding events, the occurrence rate of bleeding was 9.1%and the occurrence rate of thrombo-embolia was 3.6%. Conclusion Given 3 mg warfarin combined with subcutaneous injection of 5000 units low molecular weight heparin as initial treatment enable INR to reach steady rapidly, safely and effectively. It had guiding significance to planning clinical program.