目的 探討阿加曲班聯(lián)合低分子肝素對次大面積肺動脈栓塞患者影像學指標及血清D-二聚體和內皮素-1（ET-1）水平的影響。方法 本研究為回顧性研究，選取2019年1月—2020年12月河南省人民醫(yī)院收治的68例次大面積肺動脈栓塞患者為研究對象，根據治療方法分為對照組（n=34）和觀察組（n=34）。在常規(guī)治療的基礎上，對照組患者sc低分子肝素鈉5 000 IU/次，12 h給藥1次。觀察組在給予低分子肝素鈉的基礎上給予阿加曲班注射液，起始60 mg阿加曲班加入生理鹽水注射液稀釋至50 mL，持續(xù)48 h靜脈泵入，后予10 mg阿加曲班加入生理鹽水注射液稀釋至30 mL，持續(xù)3 h靜脈泵入，2次/d，兩組均連續(xù)治療2周。比較兩組治療前后的影像學指標變化，測定治療前后兩組患者血清D-二聚體和ET-1水平，觀察兩組患者治療期間出血不良事件的發(fā)生情況。結果 與治療前比較，治療2周后兩組患者影像學結果測定的阻塞指數（OI）和灌注指數均（PI）較明顯下降（P<0.05），觀察組患者OI和PI較對照組下降的更為明顯（P<0.05）；治療7 d后，兩組患者血清D-二聚體和ET-1水平較治療前明顯下降（P<0.05），且觀察組較對照組在治療后降低的更為明顯（P<0.05）。兩組治療期間出血不良事件的發(fā)生率比較無統(tǒng)計學意義（P>0.05）。結論 阿加曲班聯(lián)合低分子肝素治療次大面積肺動脈栓塞能加強抗凝療效，促進血栓溶解，保護肺動脈血管內皮功能，改善預后。

Objective To investigate the effects of argatroban combined with low molecular weight heparin on imaging indexes and serum D-dimer and endothelin-1(ET-1) levels in patients with sub large area pulmonary embolism. Methods Totally 68 patients with massive pulmonary embolism treated in Henan Provincial People's Hospital from January 2019 to December 2020 were retrospectively selected as the research object. They were divided into control group (n=34) and observation group (n=34) according to the treatment method. On the basis of routine treatment, patients in the control group were subcutaneously injected with 5 000 IU of low molecular weight heparin sodium once every 12 h. Patients in the observation group were given Argatroban Injection on the basis of low molecular weight heparin sodium. Initially, 60 mg argatroban was diluted to 50 mL with normal saline injection for 48 h, and then 10 mg argatroban was diluted to 30 mL with normal saline injection for three hours, twice a day. Patients in both groups were treated for two weeks. The changes of imaging indexes before and after treatment were compared between the two groups, the levels of serum D-dimer and ET-1 were measured before and after treatment, and the incidence of adverse bleeding events during treatment was observed. Results Compared with before treatment, the obstruction index (OI) and perfusion index (PI) in the two groups decreased significantly after 2 weeks of treatment (P<0.05), and the OI and PI in the observation group decreased more significantly than that in the control group (P<0.05). After seven days of treatment, the levels of serum D-dimer and ET-1 in the two groups were significantly lower than those before treatment (P<0.05), and the levels in the observation group were significantly lower than those in the control group (P<0.05). There was no significant difference in the incidence of bleeding adverse events between the two groups (P>0.05). Conclusion Argatroban combined with low molecular weight heparin can enhance the anticoagulant effect, promote thrombolysis, protect pulmonary artery endothelium and improve the prognosis.

R971