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观察达比加群治疗心房颤动(简称房颤)合并慢性肾病患者有效性与安全性。选取2013年3月~2015年3月,东莞市人民医院收治的240例房颤合并慢性肾病患者为研究对象。将肌酐清除率≥30ml/min的患者随机分为对照组1和观察组1,肌酐清除率15~29ml/min的患者随机分为对照组2和观察组2。每组60例。对照组给予华法林治疗,初始剂量为3mg/d,根据INR调整华法林剂量。观察组1组和2组分别给予达比加群110mg和55mg,2次/d,随对照组复查时间复查凝血功能指标,治疗6个月。结果显示,四组患者凝血功能指标基线水平差异无统计学意义(F=0.422、0.613、0.713、0.425,均P>0.05)。对照组治疗后血浆凝血酶原时间(PT)、国际标准化比值(INR)和血浆活化部分凝血活酶时间(APTT)均较治疗前提高,差异有统计学意义(t=7.338、3.506、4.822,均P<0.01),观察组治疗后APTT和血浆凝血酶时间(TT)均较治疗前提高,差异有统计学意义(t=6.003、10.015,均P<0.01)。对照组患者总体不良事件发生率6.67%(8/120),观察组总体不良事件发生率2.50%(3/120),差异无统计学意义(χ2=2.382,P>0.05)。四组患者血尿素氮(BUN),血β2微球蛋白(β2MG),血肌酐(Scr)变化差异无统计学意义(P>0.05)。达比加群是治疗房颤合并慢性肾病有效、安全的抗凝药物,综合考虑患者多方面因素,制定个体化的治疗措施,加强健康教育,使房颤患者认识到抗凝治疗的必要性,改善预后。
To observe the efficacy and safety of dabigatran in the treatment of atrial fibrillation (AF) patients with chronic kidney disease. Select March 2013 ~ March 2015, Dongguan City People’s Hospital admitted 240 cases of atrial fibrillation and chronic kidney disease patients as the research object. Patients with creatinine clearance ≥30ml / min were randomly divided into control group 1 and observation group 1, and patients with creatinine clearance 15 ~ 29ml / min were randomly divided into control group 2 and observation group 2. 60 cases in each group. The control group was treated with warfarin, the initial dose of 3mg / d, warfarin dose adjusted according to INR. The observation group 1 and 2 were given dabigatran 110mg and 55mg, 2 times / d, with the control group review time coagulation function indicators, treatment for 6 months. The results showed that there was no significant difference in the baseline levels of coagulation function among the four groups (F = 0.422,0.613,0.713,0.425, all P> 0.05). The plasma prothrombin time (PT), international normalized ratio (INR) and plasma activated partial thromboplastin time (APTT) in the control group after treatment were significantly higher than those before treatment (t = 7.338, 3.506, 4.822, (P <0.01). The APTT and thrombin time (TT) in observation group were significantly higher than those before treatment (t = 6.003,10.015, all P <0.01). The incidence of adverse events was 6.67% (8/120) in the control group and 2.50% (3/120) in the observation group. The difference was not statistically significant (χ2 = 2.382, P> 0.05). The blood urea nitrogen (BUN), blood β2 microglobulin (β2MG) and serum creatinine (Scr) in the four groups showed no significant difference (P> 0.05). Dabigatran is an effective and safe anticoagulant therapy for atrial fibrillation combined with chronic kidney disease. Considering various factors of patients, dabigatran is formulated with individualized treatment measures and health education to make AF patients aware of the necessity of anticoagulant therapy. Improve the prognosis.