目的 探討華法林與利伐沙班治療中危肺栓塞的療效對(duì)比。方法 選取2017年3月—2019年3月海南省第二人民醫(yī)院40例中危肺栓塞患者作為研究對(duì)象。根據(jù)隨機(jī)數(shù)字表法分為兩組，每組各20例。兩組患者在注射用尿激酶溶栓后皮下注射那屈肝素鈣注射液2 d后，對(duì)照組口服華法林鈉片，2.5 mg/d，頓服，服用5 d后停用那屈肝素鈣注射液，繼續(xù)服用華法林鈉片3個(gè)月。觀察組則口服利伐沙班片，10 mg/次，1次/d，連續(xù)服用5 d后停用那屈肝素鈣注射液，繼續(xù)服用利伐沙班片3個(gè)月。觀察兩組患者的臨床療效，同時(shí)比較兩組治療前后的血氧分壓（pO₂）、動(dòng)脈血二氧化碳分壓（pCO₂）、心率、呼吸頻率、血漿凝血酶原時(shí)間（PT）、D-二聚體（D-D）、纖維蛋白原（FIB）、組織型纖溶酶原激活物（tPA）、溶酶原激活物特異性抑制物（PAI-I）活性、血小板計(jì)數(shù)（PLT）水平。結(jié)果 治療后，觀察組治療總有效率為95.00%，顯著高于對(duì)照組的75.00%（P<0.05）。治療后，兩組pCO₂、呼吸頻率及心率均明顯降低，pO₂顯著升高（P<0.05）；且觀察組各臨床指標(biāo)顯著優(yōu)于對(duì)照組（P<0.05）。治療后，兩組D-D、PAI-I和tPA活性水平均顯著降低，F(xiàn)IB、PT和PLT水平均明顯升高（P<0.05），且觀察組各凝血-纖溶系統(tǒng)指標(biāo)水平顯著優(yōu)于對(duì)照組（P<0.05）。結(jié)論 利伐沙班抗凝治療可有效改善患者的肺功能及凝血-纖溶系統(tǒng)，療效安全顯著，在中危肺栓塞抗凝治療中具有較高的應(yīng)用價(jià)值。

Objective To compare the efficacy of warfarin and rivaroxabanin in treatment of medium-risk pulmonary embolism. Methods A total of 40 patients with medium-risk pulmonary embolism in Second People's Hospital of Hainan Province from March 2017 to March 2019 were selected as the study subjects. According to the random number table method, they were divided into two groups with 20 cases in each group. Patients in two groups were thrombolysis with Urokinase for Injection and injected with Nadroparin Calcium Injection subcutaneously for 2 days, while patients in the control group were po administered with Warfarin Sodium Tablets, 2.5 mg/d, and then stopped taking Nadroparin Calcium Injection for 5 days, and continued taking Warfarin Sodium Tablets for 3 months. Patients in the observation group were po administered with Rivaroxaban Tablets, 10 mg/time, once daily. After continuous use for 5 days, the patients stopped taking Nadroparin Calcium Injection and continued to take Rivaroxaban Tablets for 3 months. The clinical efficacy in two groups of patients was observed, the levels of PaO₂ and PaCO₂, heart rate, breathing rate, PT, the levels of D-D, FIB, tPA, PAI-I, and PLT in two groups before and after treatment were compared. Results After treatment, the total effective rate of the observation group was 95.00%, which was significantly higher than 75.00% of the control group (P<0.05). After treatment, PaCO₂, respiratory rate, and heart rate in two groups were significantly decreased, while PaO₂ was significantly increased (P<0.05). And the clinical indicators in the observation group were significantly better than those of the control group (P<0.05). After treatment, the activity levels of D-D, PAI-I and tPA in two groups were significantly decreased, while the levels of FIB, PT and PLT were significantly increased (P<0.05), and the indicators of coagulation and fibrinolysis in the observation group were significantly better than those in the control group (P<0.05). Conclusion Rivaroxabanin anticoagulant therapy can effectively improve the pulmonary function and the coagulation and fibrinolysis system of the patients, with significant efficacy and safety, and has high application value in the anticoagulant therapy of medium-risk pulmonary embolism.

R974