目的 探讨阿加曲班联合低分子肝素对次大面积肺动脉栓塞患者影像学指标及血清D-二聚体和内皮素-1（ET-1）水平的影响。方法 本研究为回顾性研究，选取2019年1月—2020年12月河南省人民医院收治的68例次大面积肺动脉栓塞患者为研究对象，根据治疗方法分为对照组（n=34）和观察组（n=34）。在常规治疗的基础上，对照组患者sc低分子肝素钠5 000 IU/次，12 h给药1次。观察组在给予低分子肝素钠的基础上给予阿加曲班注射液，起始60 mg阿加曲班加入生理盐水注射液稀释至50 mL，持续48 h静脉泵入，后予10 mg阿加曲班加入生理盐水注射液稀释至30 mL，持续3 h静脉泵入，2次/d，两组均连续治疗2周。比较两组治疗前后的影像学指标变化，测定治疗前后两组患者血清D-二聚体和ET-1水平，观察两组患者治疗期间出血不良事件的发生情况。结果 与治疗前比较，治疗2周后两组患者影像学结果测定的阻塞指数（OI）和灌注指数均（PI）较明显下降（P<0.05），观察组患者OI和PI较对照组下降的更为明显（P<0.05）；治疗7 d后，两组患者血清D-二聚体和ET-1水平较治疗前明显下降（P<0.05），且观察组较对照组在治疗后降低的更为明显（P<0.05）。两组治疗期间出血不良事件的发生率比较无统计学意义（P>0.05）。结论 阿加曲班联合低分子肝素治疗次大面积肺动脉栓塞能加强抗凝疗效，促进血栓溶解，保护肺动脉血管内皮功能，改善预后。
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.