目的 探討心房顫動患者低劑量長期使用華法林對患者腦卒中和凝血指標(biāo)的影響。方法 選擇2016年1月—2018年12月喀什地區(qū)第一人民醫(yī)院收治的心房顫動患者213例作為研究對象，按照隨機數(shù)字表法將患者分為3組，每組各71例。對照組患者使用阿司匹林腸溶片，200 mg/d。華法林高劑量組患者在使用華法林鈉片前測定抗凝強度國際化標(biāo)準(zhǔn)比率（INR）作為基礎(chǔ)值，初始劑量為2.5 mg/d，每隔3~5 d復(fù)查IRN，根據(jù)IRN調(diào)整使用劑量，每次增加0.625 mg，直至復(fù)查INR達(dá)標(biāo)，達(dá)標(biāo)時IRN值為2.1~3.0。華法林低劑量組患者使用華法林初始量為1.25 mg/d，每隔3~5 d復(fù)查IRN，達(dá)標(biāo)時IRN值為1.5~2.0。根據(jù)IRN調(diào)整使用劑量，如果INR<1.5，每次增加0.625 mg，直至復(fù)查INR達(dá)標(biāo)；如果INR>2.1，將華法林劑量減少0.625 mg。INR不穩(wěn)定時，連續(xù)達(dá)標(biāo)2次后以該劑量作為維持劑量，每月復(fù)查1次，直至INR達(dá)標(biāo)。3組均治療隨訪18個月。觀察并比較兩組患者的腦卒中發(fā)生情況、凝血指標(biāo)、華法林用量、達(dá)INR標(biāo)準(zhǔn)時間和不良反應(yīng)發(fā)生情況。結(jié)果 隨訪后，華法林高劑量組腦卒中發(fā)生率為2.82%，華法林低劑量組為4.23%，均明顯低于對照組的14.08%，組間差異具有統(tǒng)計學(xué)意義（P<0.05）。治療后，3組活化部分凝血活酶時間（APTT）、凝血酶原時間（PT）均明顯延長（P<0.05），華法林高劑量和低劑量APTT、PT顯著優(yōu)于對照組，組間差異具有統(tǒng)計學(xué)意義（P<0.05）。華法林低劑量組華法林使用量和INR達(dá)標(biāo)準(zhǔn)值時間均明顯低于華法林高劑量組（P<0.05）。治療期間，華法林高劑量組出血、腹部不適等不良反應(yīng)發(fā)生率為9.86%，華法林低劑量組為5.63%，均明顯低于對照組的29.58%（P<0.05）。結(jié)論 心房顫動患者長期使用低劑量華法林能夠有效的達(dá)到預(yù)防腦卒中的效果，其療效與標(biāo)準(zhǔn)抗凝強度相當(dāng)，且明顯優(yōu)于阿司匹林，具有較高的臨床應(yīng)用價值，可推廣使用。

Objective To investigate the effects of long-term low-dose warfarin on stroke and coagulation indexes in patients with atrial fibrillation. Methods A total of 213 patients with atrial fibrillation admitted to the the First People's Hospital in Kashgar from January 2016 to December 2018 were selected as the research objects, and the patients were divided into 3 groups according to the random number table method, with 71 patients in each group. Patients in the control group were po administered with Aspirin Enteric-coated Tablets at 200 mg/d. In the high-dose warfarin group, INR was measured as the base value before the use of Warfarin Sodium Tablets. The initial dose was 2.5 mg/d, and IRN was rechecked every 3 to 5 days. The dosage should be adjusted according to IRN and increased by 0.625 mg each time until the INR was rechecked, and the IRN value was 2.1-3.0. Patients in the lowdose warfarin group, the initial dose of warfarin was 1.25 mg/d, and IRN was checked every 3 to 5 days, and the IRN value was 1.5 to 2.0 when the target was reached. Adjust the dosage according to IRN. If INR < 1.5, increase 0.625 mg each time until INR meets the standard. If INR > 2.1, the warfarin dose was reduced by 0.625 mg. When INR is unstable, the dose shall be used as the maintenance dose after reaching the standard for two consecutive times, and the dose shall be reviewed once a month until reaching the standard for INR. All the 3 groups were followed up for 18 months. The incidence of stroke, coagulation indexes, warfarin dosage, time to INR standard, and adverse reactions were observed and compared between two groups. Results After follow-up, the incidence of stroke was 2.82% in the high-dose warfarin group and 4.23% in the low-dose warfarin group, both of which were significantly lower than 14.08% in the control group, with statistically significant difference between the two groups (P<0.05). After treatment, APTT and PT in three groups were significantly prolonged (P<0.05), and APTT and PT at high and low doses of warfarin were significantly better than those in the control group, with statistically significant differences between groups (P<0.05). The dosage of warfarin and the time for INR to reach the standard value in low-dose warfarin group were significantly lower than those in the high-dose warfarin group (P<0.05). During the treatment, the incidence of adverse reactions, such as bleeding and abdominal discomfort, was 9.86% in the high-dose warfarin group, and 5.63% in the low-dose warfarin group, which were significantly lower than 29.58% in the control group (P<0.05). Long-term use of low-dose warfarin in patients with atrial fibrillation can effectively achieve the effect of preventing stroke. Its efficacy is comparable to standard anticoagulant intensity, and significantly superior to aspirin. Conclusion It has high clinical application value and can be widely used.

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