目的 比較阿加曲班和普通肝素治療下肢深靜脈血栓及其并發(fā)癥肺栓塞的臨床療效和不良反應(yīng)。方法 將200例下肢深靜脈血栓形成患者隨機(jī)分成治療組（100例）和對(duì)照組（100例），對(duì)照組患者入院后絕對(duì)臥床休息，患肢制動(dòng)、抬高，忌按壓、熱敷；使用肝素鈉抗凝，肝素鈉注射液2 mL＋生理鹽水10 mL，用微量泵以2 mL/h持續(xù)靜脈泵入，治療7 d后停用普通肝素，改為口服華法令治療；使用注射用纖溶酶溶栓；合并肺栓塞者給予3 L/min吸氧及前列地爾擴(kuò)張支氣管。治療組患者給予阿加曲班注射液抗凝，開(kāi)始2 d，60 mg/d，持續(xù)靜脈泵入；后5 d，20 mg/d，3 h內(nèi)泵入，2 次/d。治療7 d后改為口服華法令，其他治療方案同對(duì)照組患者。治療時(shí)間為2周，比較兩組患者治療前后癥狀和體征的變化，并在治療過(guò)程中監(jiān)測(cè)凝血酶原時(shí)間、活化部分凝血活酶時(shí)間及血小板。結(jié)果 治療2周后，兩組患者患肢疼痛、腫脹，肺栓塞患者咳嗽、咯血、呼吸困難等癥狀均有好轉(zhuǎn)，治療組患者癥狀改善更明顯，且患肢周徑較治療前明顯減?。≒＜0.05），治療組和對(duì)照組總有效率分別為98%、90%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。治療組無(wú)血小板減少癥（HIT）發(fā)生，對(duì)照組發(fā)生1例；對(duì)照組與治療組相比，PT及APTT波動(dòng)較大，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。結(jié)論 阿加曲班治療下肢深靜脈血栓及其并發(fā)的肺栓塞與常規(guī)普通肝素治療相比臨床療效及安全性均有提高，值得臨床推廣。

Objective To compare the curative effect and adverse reaction of argatroban and heparin in lower extremity deep venous thrombosis (DVT) and its complication of pulmonary embolism. Methods Patients (200 cases) with lower extremity DVT were randomly divided into the treatment (100 cases) and control (100 cases) groups. The patients in the control group were kept on absolute bed rest, at the same time, the affected limbs were avoided pressing and hot compress. The heparin sodium injection was used to anticoagulate, and the patients were administered with heparin sodium injection 2 mL in 10 mL normal saline, 2 mL/h, by iv continuous pumping, for 7 d. After 7 d, the heparin was instead by warfarin. Fibrinolytic enzyme injection was used for thrombolysis. The patients with pulmonary embolism were given 3 L/min oxygen and Alprostadil to dilate bronchus. Patients in the treatment group were administered with Argatroban Injection 60 mg/d by iv continuous pumping in first 2 d and 20 mg/d pumped in 3 h, twice daily in last 5 d. After 7 d, Argatroban Injection was instead by warfarin. Other approaches were the same as the control group. The period of the treatment was 2 weeks. Changes of symptoms and signs were compared between two groups, at the same time, PT, APTT, and platelet were also monitored. Results After the treatment, the limbs pain, swelling, symptoms of cough, hemoptysis, and breathing difficulties of all patients were improved. The symptoms in the treatment group were improved more obviously, and the perimeter of the suffered limb was significant decreased after the treatment (P < 0.05). The total efficacy rates in the treatment and control groups were 98% and 90%, respectively, and the difference was statistically significant (P < 0.05). There was no thrombocytopenia in the treatment group, whereas one heparin induced thrombocytopenia was found in the control group. Changes of prothrombin time and activated partial prothrombin time in the control group were more obvious than those in the treatment group (P < 0.05). Conclusion Argatroban has the better treatment efficacy and safety compared with traditional heparin in treatment of lower extremity DVT and its complication of pulmonary embolism, which is suitable for clinical usage.