目的 探讨华法林与利伐沙班治疗中危肺栓塞的疗效对比。方法 选取2017年3月—2019年3月海南省第二人民医院40例中危肺栓塞患者作为研究对象。根据随机数字表法分为两组，每组各20例。两组患者在注射用尿激酶溶栓后皮下注射那屈肝素钙注射液2 d后，对照组口服华法林钠片，2.5 mg/d，顿服，服用5 d后停用那屈肝素钙注射液，继续服用华法林钠片3个月。观察组则口服利伐沙班片，10 mg/次，1次/d，连续服用5 d后停用那屈肝素钙注射液，继续服用利伐沙班片3个月。观察两组患者的临床疗效，同时比较两组治疗前后的血氧分压（pO₂）、动脉血二氧化碳分压（pCO₂）、心率、呼吸频率、血浆凝血酶原时间（PT）、D-二聚体（D-D）、纤维蛋白原（FIB）、组织型纤溶酶原激活物（tPA）、溶酶原激活物特异性抑制物（PAI-I）活性、血小板计数（PLT）水平。结果 治疗后，观察组治疗总有效率为95.00%，显著高于对照组的75.00%（P<0.05）。治疗后，两组pCO₂、呼吸频率及心率均明显降低，pO₂显著升高（P<0.05）；且观察组各临床指标显著优于对照组（P<0.05）。治疗后，两组D-D、PAI-I和tPA活性水平均显著降低，FIB、PT和PLT水平均明显升高（P<0.05），且观察组各凝血-纤溶系统指标水平显著优于对照组（P<0.05）。结论 利伐沙班抗凝治疗可有效改善患者的肺功能及凝血-纤溶系统，疗效安全显著，在中危肺栓塞抗凝治疗中具有较高的应用价值。

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