目的 探讨华法林联合低分子肝素治疗晚期肺癌急性非大面积肺栓塞的疗效观察。方法 选择2010年1月-2014年9月天津市第一中心医院急诊科收治的晚期肺癌急性非大面积肺栓塞患者380例,随机分为治疗组和对照组,每组各190例。对照组皮下注射低分子量肝素钠注射液,5 000 U/次,2次/d,连续2 d测定国际标准化比率(INR)或凝血酶原时间(PT)延长至正常值的1.5~2.5倍时停用。治疗组在对照组治疗基础上口服华法林钠片,5 mg/d,1次/d。两组均连续治疗2周。观察两组临床疗效,同时比较治疗前后两组血氧分压(pO₂)、二氧化碳分压(pCO₂)、血氧饱和度(SaO₂)、肺动脉压力、呼吸症状评分、卡氏(KPS)评分的变化情况。结果 治疗后,对照组和治疗组的总有效率分别为68.95%、78.42%,两组比较差异有统计学意义(P<0.05)。治疗后,两组pO₂、SaO₂、KPS评分均显著升高,pCO₂、肺动脉压力、呼吸症状评分均显著降低,同组治疗前后差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度优于对照组,两组比较差异有统计学意义(P<0.05)。结论 华法林联合低分子肝素治疗晚期肺癌合并急性非大面积肺栓塞具有较好的临床疗效,能够显著改善患者的呼吸症状,缓解患者呼吸困难,具有一定的临床推广应用价值。

Objective To explore the clinical effect of warfarin combined with low-molecular-weight heparin in treatment of advanced lung cancer with acute massive pulmonary embolism.Methods Patients (380 cases) with advanced lung cancer with acute massive pulmonary embolism in Department of Emergency in Tianjin First Center Hospital from January 2010 to September 2014 were randomly divided into control and treatment groups. Each group had 190 cases. The patients in the control group were sc administered with Low-Molecular-Weight Heparin Sodium Injection, 5 000 U/time, twice daily. International standardization ratio (INR) or PT were measured for 2 d, Low-Molecular-Weight Heparin Sodium Injection was stopped until INR and PT extended to 1.5-2.5 times the normal levels. The patients in the treatment group were po administered with Warfarin Sodium Tablets, 5 mg/d, once daily. The patients in two groups were treated for two weeks. After treatment, the efficacy was evaluated, and the changes of pO₂, pCO₂, SaO₂, pulmonary artery pressure, and respiratory symptom scores in two groups were compared.Results After treatment, the efficacies in the control and treatment groups were 68.95% and 78.42%, respectively, and there were differences between two groups (P < 0.05). After treatment, pO₂, SaO₂, and KPS scores in two groups were significantly increased, and pCO₂, pulmonary artery pressure, and respiratory symptom scores was significantly decreased, and the difference was statistically significant in the same group (P < 0.05). After treatment, the observational indexes in the treatment group were significantly better than those in the control group, withsignificant difference between two groups (P < 0.05).Conclusion Warfarin combined with low-molecular-weight heparin has clinical curative effect in treatment of advanced lung cancer with acute massive pulmonary embolism, and can significantly improve the respiratory symptoms, also can alleviate breathing difficulties, which has a certain clinical application value.

天津市卫生局科技基金资助项目(2013KY06)