中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
19期
19-22
,共4页
肺栓塞%抗凝药%医院外治疗%肺栓塞严重程度指数%自我管理
肺栓塞%抗凝藥%醫院外治療%肺栓塞嚴重程度指數%自我管理
폐전새%항응약%의원외치료%폐전새엄중정도지수%자아관리
Pulmonary embolism%Anticoagulants%Deinstitutionalization%Pulmonary embolism severity index%Self-management
目的 评估对低肺栓塞严重程度指数(PESI)急性肺栓塞(APE)患者进行院外自我抗凝管理的疗效及安全性.方法 将PESI分级Ⅰ～Ⅱ级的68例APE患者按随机数字表法分为院外治疗组和住院治疗组,每组34例.所有患者均给予低分子量肝素联合口服抗凝药物治疗,院外治疗组进行自我抗凝管理.观察两组患者治疗后2周及3个月时的疗效,包括静脉血栓栓塞(VTE)的复发情况、国际标准化比值(INR)达标时间、VTE相关的急救次数、出血事件的发生及总体病死率.结果 治疗期间住院治疗组2例(5.9％,2/34)VTE复发,院外治疗组仅1例(2.9％,1/34) VTE复发,差异无统计学意义(P＞0.05).住院治疗组INR达标时间(8.5±2.9)d,明显短于院外治疗组的(16.1±4.4)d,差异有统计学意义(P＜0.01).两组患者VTE相关的急救次数比较差异无统计学意义(P＞0.05).68例患者中仅院外治疗组发生1例严重出血、1例死亡.结论 对于PESI分级Ⅰ～Ⅱ级的APE患者早期进行院外自我抗凝管理,安全有效,可大大缩短住院时间,减轻患者的物质及精神负担.
目的 評估對低肺栓塞嚴重程度指數(PESI)急性肺栓塞(APE)患者進行院外自我抗凝管理的療效及安全性.方法 將PESI分級Ⅰ～Ⅱ級的68例APE患者按隨機數字錶法分為院外治療組和住院治療組,每組34例.所有患者均給予低分子量肝素聯閤口服抗凝藥物治療,院外治療組進行自我抗凝管理.觀察兩組患者治療後2週及3箇月時的療效,包括靜脈血栓栓塞(VTE)的複髮情況、國際標準化比值(INR)達標時間、VTE相關的急救次數、齣血事件的髮生及總體病死率.結果 治療期間住院治療組2例(5.9％,2/34)VTE複髮,院外治療組僅1例(2.9％,1/34) VTE複髮,差異無統計學意義(P＞0.05).住院治療組INR達標時間(8.5±2.9)d,明顯短于院外治療組的(16.1±4.4)d,差異有統計學意義(P＜0.01).兩組患者VTE相關的急救次數比較差異無統計學意義(P＞0.05).68例患者中僅院外治療組髮生1例嚴重齣血、1例死亡.結論 對于PESI分級Ⅰ～Ⅱ級的APE患者早期進行院外自我抗凝管理,安全有效,可大大縮短住院時間,減輕患者的物質及精神負擔.
목적 평고대저폐전새엄중정도지수(PESI)급성폐전새(APE)환자진행원외자아항응관리적료효급안전성.방법 장PESI분급Ⅰ～Ⅱ급적68례APE환자안수궤수자표법분위원외치료조화주원치료조,매조34례.소유환자균급여저분자량간소연합구복항응약물치료,원외치료조진행자아항응관리.관찰량조환자치료후2주급3개월시적료효,포괄정맥혈전전새(VTE)적복발정황、국제표준화비치(INR)체표시간、VTE상관적급구차수、출혈사건적발생급총체병사솔.결과 치료기간주원치료조2례(5.9％,2/34)VTE복발,원외치료조부1례(2.9％,1/34) VTE복발,차이무통계학의의(P＞0.05).주원치료조INR체표시간(8.5±2.9)d,명현단우원외치료조적(16.1±4.4)d,차이유통계학의의(P＜0.01).량조환자VTE상관적급구차수비교차이무통계학의의(P＞0.05).68례환자중부원외치료조발생1례엄중출혈、1례사망.결론 대우PESI분급Ⅰ～Ⅱ급적APE환자조기진행원외자아항응관리,안전유효,가대대축단주원시간,감경환자적물질급정신부담.
Objective To evaluate the efficacy and safety of self-management anticoagulation treatment for low pulmonary embolism severity index (PESI) outpatient with acute pulmonary embolism (APE).Methods Sixty-eight patients with APE of PESI grade Ⅰ-Ⅱ were divide into inpatient group and outpatient group with 34 cases each by random digits table.All the patients were treated with low molecular heparin followed by oral anticoagulation,and self-management was used in outpatient group.The efficacy was observed within 14 days and 3 months.The efficacy outcome included recurrent venous thromboembolism (VTE),standardization time of international normalized ratio (INR),VTE-related emergency department visit times,bleeding events and total mortality.Results There were 2 cases(5.9％,2/34) in inpatient group and 1 case (2.9％,1/34) in outpatient group with recurrent VTE,and there was no statistical significance between two groups (P ＞ 0.05).Standardization time of INR in inpatient group [(8.5 ± 2.9) d] was shorter than that in outpatient group [(16.1 ± 4.4) d],and there was significant difference (P＜ 0.01).There was no significant difference in the VTE-related emergency department visit times between two groups (P ＞ 0.05).There was 1 case with major bleeding and 1 death respectively in outpatient group.Conclusion It is effective and safe to give early self-management anticoagulation treatment to APE patients with PESI grade Ⅰ-Ⅱ,which could shorten time spending in hospital and release burden both physically and mentally.
