肺动脉血栓栓塞与凝血-纤溶因子关系的临床研究※

目的探讨肺动脉血栓栓塞患者与组织型纤溶酶原激活物（t-PA）和组织型纤溶酶原激活物抑制物-1（PAI-1）血浆水平的关系。方法选取2008年6月～2011年6月间在我院进行住院治疗的53例肺动脉血栓栓塞患者,作为观察组,另外选择同期健康体检者57例作为对照组。通过聚合链酶式反应（PCR）来检测肺动脉血栓栓塞患者基因型及其多态性;并通过酶联免疫吸附法进行t-PA和PAI-1血浆水平的检测,比较两组患者的凝血-纤溶因子水平。结果通过PCR检测发现PTE患者主要有三种PAI-1基因型,主要以4G/4G和4G/5G基因型为主,并且该基因型PAI-1水平显著高于5G/5G基因型（P＜0.05）;ELISA法检测显示观察组t-PA水平（53.14±18.24）μg/L显著低于对照组的（70.45±20.08）μg/L,（t=4.7207,P＜0.01）;而PAI-1水平（58.74±18.65）μg/L显著高于对照组（48.62±15.60）μg/L（t=3.0948, P＜0.05）。结论肺动脉血栓栓塞患者与健康者相比,显然具备较低的纤溶状态。     

肺动脉栓塞误诊为心脏疾病39例临床分析

目的对39例肺动脉栓塞患者的临床症状及体征进行分析比较。方法依据患者症状体征及实验室检查。结果肺动脉误诊率为49.3%。结论肺动脉栓塞症状多种多样，误诊率极高，日常工作要警惕。     

运动疗法及气压治疗联合预防脑出血深静脉血栓形成的影响

深静脉血栓形成是指血液在深静脉腔内不正常的凝结,阻塞静脉管腔,导致静脉回流障碍,造成不同程度的慢性深静脉阻塞.全身主干静脉均可发病,最常见的是下肢及下腔静脉血栓形成,尤其是髂-股静脉血栓形成,一旦栓子脱落可造成重要脏器的栓塞,危及患者的生命.脑出血患侧一般处于意识障碍、长期卧床和脱水治疗等状态,很容易发生静脉血栓,如不采取有效预防措施,及时发现治疗,可导致病人下肢功能完全或部分丧失而致残,并可能发生致命的肺栓塞.     

大剂量维生素C致深静脉血栓形成1例

目的探讨维生素C的临床合理应用。方法查阅临床应用大剂量维生素C的病历,回顾性分析1例下肢深静脉血栓形成、脱落,引起患者肺栓塞死亡病例,查找引起患者右下肢深静脉血栓形成的原因。结果大剂量维生素C的使用是引起患者深静脉血栓形成的主要因素。结论临床医师应按照说明书合理使用维生素C,避免不良反应事件的发生。     

不同年龄段肺栓塞临床观察及危险因素

目的探讨不同年龄段肺栓塞的危险因素及临床特点。方法选取110例肺栓塞患者,以60岁为分界点将其分为老年组和非老年组,比较两组患者的危险因素及临床症状发生率的不同特点。结果老年组有心脑血管病史的例数明显多于非老年组,患肿瘤的例数也更多,而下肢深静脉血栓的比例均较高;呼吸困难是两组患者均存在且占多数的临床表现,而在咯血与晕厥两项上两组差异有统计学意义(P<0.05)。结论老年患者出现肺动脉栓塞的伴随症状较多,危险因素多。     

临床妇科盆腔手术后下肢深静脉血栓的形成机理

目的探讨妇科盆腔手术后下肢深静脉血栓的形成机理。方法针对实施妇科盆腔手术的125例患者术后下肢深静脉血栓的发生率等指标进行比较分析。结果术后有20例患者发生下肢深静脉血栓,发生率为16.0%,发生时间集中在术后1周时间内,平均为4.2 d;术后有105例患者未发生下肢深静脉血栓。结论下肢深静脉血栓在临床妇科盆腔手术后具有较高的发生率,早期筛查该病症的手段是检测D-二聚体及抗凝血酶水平检测并与静脉超声检查相结合。     

中西医结合治疗下肢深静脉血栓形成疗效观察

目的探讨中西医结合治疗下肢深静脉血栓形成的疗效.方法将68例下肢深静脉血栓形成的患者随机分为治疗组35例,采用中西医结合治疗,对照组33例,采用单纯西医治疗.比较两组治疗结果.结果治疗组疗效优于对照组,P〈0.05.结论中西医结合治疗下肢深静脉血栓形成效果良好.     

创伤病人术后大量输液大量饮水及加强锻炼对下肢深静脉血栓影响

目的 探讨创伤病人术后进行大量输液、大量饮水及加强锻炼对下肢深静脉血栓的影响.方法 选取本院2008 年12 月到2010 年12 月收治的201 例创伤术后患者,随机分成观察组101 例,对照组100 例,对照组进行常规术后护理,观察组在常规术后护理的同时进行大量输液、大量饮水及加强锻炼,比较两组患者的下肢深静脉血栓发生率.结果 观察组术后出现下肢静脉血栓5 例,发生率4.95%;对照组术后出现下肢静脉血栓29 例,发生率29%.两组在下肢静脉血栓发生率上具有显著性差异,(χ2 =8.96,P<0.05),有统计学意义.结论 对于创伤病人术后给予大量输液、大量饮水及加强锻炼和有效减少下肢深静脉血栓的形成,值得临床推广使用.     

产褥感染临床治疗分析

分娩及产褥期生殖道受病原体侵袭而引起局部或全身的感染,称为产褥感染.产褥感染的发病率为6%,是产褥期最常见的严重并发症,也是导致孕产妇死亡的重要原因之一.本文从产褥感染病因和发病机制入手,探讨产褥感染临床治疗方法.     

低分子肝素钙联合间歇气压治疗预防重症监护病房患者深静脉血栓形成效果观察

目的探讨低分子肝素钙联合间歇气压治疗预防重症监护病房(ICU)患者深静脉血栓形成的临床效果。方法将2012年1月至2013年1月在我院ICU进行治疗的118例重症患者分成两组,对照组应用常规方法预防深静脉血栓形成,治疗组在对照组基础上应用低分子肝素钙联合间歇充气装置预防深静脉血栓形成,比较两组患者的深静脉血栓发生率。结果治疗组在治疗过程中死亡2例,对照组在治疗过程中死亡3例,治疗组深静脉血栓形成发生率为5.1%,对照组深静脉血栓形成发生率为17.0%,治疗组的深静脉血栓形成发生率明显低于对照组(P<0.01),差异有统计学意义。结论低分子肝素钙联合间歇气压装置可降低ICU重症患者深静脉血栓形成的发生率,可在临床中推广应用。     

甲泼尼龙与利伐沙班联合治疗慢性阻塞性肺疾病急性加重期合并肺栓塞患者的临床效果

目的探讨甲泼尼龙与利伐沙班联合治疗慢性阻塞性肺疾病急性加重期合并肺栓塞患者的临床效果。方法选取2019年3月至2020年5月江门市中心医院收治的76例慢性阻塞性肺疾病急性加重期合并肺栓塞患者作为研究对象,按随机数字表法分为对照组与观察组,各38例。对照组给予利伐沙班治疗,观察组在对照组基础上联合甲泼尼龙治疗,比较两组临床疗效、血气分析指标及血清心肌肌钙蛋白(cTnⅠ)、凝血功能、不良反应。结果观察组治疗有效率92.11%,高于对照组的73.68%,差异有统计学意义(P<0.05)。治疗前,两组血气分析指标、血清cTnⅠ及凝血功能指标比较,差异无统计学意义(P>0.05);治疗后,观察组动脉血氧分压(PaO₂)高于对照组,动脉血二氧化碳分压(PaCO₂)、cTnⅠ低于对照组,活化部分凝血酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)短于对照组,差异有统计学意义(P<0.05)。两组治疗后未出现明显不良反应。结论甲泼尼龙与利伐沙班联合治疗慢性阻塞性肺疾病急性加重期合并肺栓塞能改善血气分析指标和凝血功能,提高临床疗效,且安全性高。     

髋关节置换术后常见的并发症及治疗

目的探讨髋关节置换术后常见的并发症以及治疗方法。方法收集我院50例老年患者髋关节置换术后的病例,总结出现并发症的情况,分析病因以及相应的治疗对策。结果 50例老年患者出现并发症的有7例,占14%;肺内感染1例,占2%;深静脉血栓1例,占2%;髋关节感染1例,占2%;泌尿系感染2例,占4%;肺内感染1例,占2%;假体周围骨折1例,占2%;假体脱位1例,占2%。结论人工髋关节置换术是近年来普遍应用于老年患者的髋关节重建,只要我们术前充分准备,术中精细操作,术后合理处置是防止术后并发症的有效方法。     

脑梗死合并肺部感染临床分析

目的分析探讨急性脑梗死合并肺部感染的危险因素,以便积极预防及治疗,提高疗效,降低死亡风险。方法回顾性分析2006年12月～2013年8月本院收治的180例急性脑梗死患者,分为肺部感染组90例和非感染组90例,对相关危险因素进行对照分析。结果肺部感染组合并吞咽困难、意识障碍、大面积脑梗死以及慢性阻塞性肺疾病、冠心病、糖尿病等基础疾病较非感染组明显升高。结论年龄、COPD病史、吞咽困难、意识障碍、大面积脑梗死以及基础疾病冠心病、糖尿病是脑梗死合并肺部感染的危险因素,临床应高度重视,并积极预防及治疗。     

78例慢性肺源性心脏病并发心律失常临床分析

目的本文在临床上对患有慢性肺源性心脏病并发心律失常患者的表现进行了简要分析。方法本文主要对本院于2010年10月到2011年10月收治的121例慢性肺源性心脏病患者的临床资料进行了分析。结果心电图和心电监护的检查结果表明,在121例调查的慢性肺源性心脏病患者中并发心律失常者有78例,达到了64.46%。心律失常的表现为窦性心动过速、窦性心动过缓、心房颤动、心房扑动、阵发性房性心动过速及阵发性室性心动过速等。结论在我国的慢性心源性心脏病患者中伴有心律失常较为常见,而且由于肺源性心脏病并发心律失常的表现有多种类型。为此,我们对121例患者中78例慢性肺源性心脏病并发心律失常的临床分析中,首先要从心电图着手以便于更深刻的了解该如何对其进行诊断和治疗。     

Economic evaluation of the use of enoxaparin for thromboprophylaxis in acutely ill medical patients

SUMMARY

The objective of this study was to assess the cost-effectiveness of prophylaxis for venous thromboembolism (VTE) in acutely ill medical patients using 40 mg enoxaparin od compared with unfractionated heparin (UFH) and placebo. An established decision tree model based on epidemiological data, clinical trials, and a recent meta-analysis was used to evaluate costs and consequences of alternative means of thromboprophylaxis in medical patients. Primary outcome measures were episodes of VTE (deep vein thrombosis or pulmonary embolism) and major bleeding. Secondary effectiveness measures included estimated mortality. In-hospital drug costs and administration time, in conjunction with long-term VTE complications up to 15 years and major bleeding, were considered. Results were estimated for a hypothetical cohort of 100 patients. The expected cost per 100 patients was £9,992 with enoxaparin 40 mg od, £9,972 with UFH 5000 IU bd and £8,781 with no prophylaxis. The expected number of episodes of VTE per 100 patients was 1.2 with enoxaparin 40 mg od, 1.4 with UFH 5000 IU bd and 3.2 with no prophylaxis. The expected number of episodes of major bleeding per 100 patients was 1.7 with enoxaparin 40 mg od, 3.5 with UFH 5000 IU bd and 1.1 with no prophylaxis. The cost-effectiveness ratios for enoxaparin compared to no prophylaxis were £796 per VTE event avoided (taking into account the small increase in bleeding). In acutely ill medical patients, enoxaparin 40 mg od was found to be cost-effective compared with no thromboprophylaxis. Compared to UFH prophylaxis, enoxaparin was found to be cost neutral.     

Cost-effectiveness of rivaroxaban compared with enoxaparin plus a vitamin K antagonist for the treatment of venous thromboembolism

Background:

Venous thromboembolism (VTE), comprised of deep vein thrombosis (DVT) and pulmonary embolism (PE), is commonly treated with a low-molecular-weight heparin such as enoxaparin plus a vitamin K antagonist (VKA) to prevent recurrence. Administration of enoxaparin?+?VKA is hampered by complexities of laboratory monitoring and frequent dose adjustments. Rivaroxaban, an orally administered anticoagulant, has been compared with enoxaparin?+?VKA in the EINSTEIN trials. The objective was to evaluate the cost-effectiveness of rivaroxaban compared with enoxaparin?+?VKA as anticoagulation treatment for acute, symptomatic, objectively-confirmed DVT or PE.

Methods:

A Markov model was built to evaluate the costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios associated with rivaroxaban compared to enoxaparin?+?VKA in adult patients treated for acute DVT or PE. All patients entered the model in the ‘on-treatment’ state upon commencement of oral rivaroxaban or enoxaparin?+?VKA for 3, 6, or 12 months. Transition probabilities were obtained from the EINSTEIN trials during treatment and published literature after treatment. A 3-month cycle length, US payer perspective ($2012), 5-year time horizon and a 3% annual discount rate were used.

Results:

Treatment with rivaroxaban cost $2,448 per-patient less and was associated with 0.0058 more QALYs compared with enoxaparin?+?VKA, making it a dominant economic strategy. Upon one-way sensitivity analysis, the model’s results were sensitive to the reduction in index VTE hospitalization length-of-stay associated with rivaroxaban compared with enoxaparin?+?VKA. At a willingness-to-pay threshold of $50,000/QALY, probabilistic sensitivity analysis showed rivaroxaban to be cost-effective compared with enoxaparin?+?VKA approximately 76% of the time.

Limitations:

The model did not account for the benefits associated with an oral and minimally invasive administration of rivaroxaban. ‘Real-world’ applicability is limited because data from the EINSTEIN trials were used in the model. Also, resource utilization and costs were based on the US healthcare system.

Conclusion:

Rivaroxaban is a cost-effective option for anticoagulation treatment of acute VTE patients.     

Length of stay and economic consequences with rivaroxaban vs enoxaparin/vitamin K antagonist in patients with DVT and PE: findings from the North American EINSTEIN clinical trial program

Objective:

Venous thromboembolism (VTE) (deep vein thrombosis [DVT] and pulmonary embolism [(PE]) represents a substantial economic burden to the healthcare system. Using data from the randomized EINSTEIN DVT and PE trials, this North American sub-group analysis investigated the potential of rivaroxaban to reduce the length of initial hospitalization in patients with acute symptomatic DVT or PE.

Methods:

A post-hoc analysis of hospitalization and length-of-stay (LOS) data was conducted in the North American sub-set of patients from the randomized, open-label EINSTEIN trial program. Patients received either rivaroxaban (15?mg twice daily for 3 weeks followed by 20?mg once daily; n?=?405) or dose-adjusted subcutaneous enoxaparin overlapping with (guideline-recommended ‘bridging’ therapy) and followed by a vitamin K antagonist (VKA) (international normalized ratio?=?2.0–3.0; n?=?401). The open-label study design allowed for the comparison of LOS between treatment arms under conditions reflecting normal clinical practice. LOS was evaluated using investigator records of dates of admission and discharge. Analyses were carried out in the intention-to-treat population using parametric tests. Costs were applied to the LOS based on weighted mean cost per day for DVT and PE diagnoses obtained from the Healthcare Cost and Utilization Project dataset.

Results:

Of 382 patients hospitalized, 321 (84%), had acute symptomatic PE; few DVT patients required hospitalization. Similar rates of VTE patients were hospitalized in the rivaroxaban and enoxaparin/VKA treatment groups, 189/405 (47%) and 193/401 (48%), respectively. In hospitalized VTE patients, rivaroxaban treatment produced a 1.6-day mean reduction in LOS (median?=?1 day) compared with enoxaparin/VKA (mean?=?4.5 vs 6.1; median?=?3 vs 4), translating to total costs that were $3419 lower in rivaroxaban-treated patients.

Conclusion:

In hospitalized North American patients with VTE, treatment with rivaroxaban produced a statistically significant reduction in LOS. When treating DVT and PE patients, clinicians should consider newer anti-coagulants with less complex treatment regimens.     

健康教育对肺结核患者负性情绪的影响

目的：探讨健康教育对肺结核患者负性情绪的影响。方法选取80例肺结核患者随机分为研究组和对照组,各40例。所有患者都行常规治疗,并给予常规护理,对照组患者给予常规指导,研究组患者给予健康教育。对比两组患者入、出院时的抑郁、焦虑程度。结果两组患者入院时的抑郁和焦虑得分比较,差异无统计学意义（P＞0.05）;而出院时研究组患者得分均低于对照组（P＜0.05）。结论健康教育可有效的改善肺结核患者的负性情绪。     

Factors associated with adherence to phosphodiesterase type 5 inhibitors for the treatment of pulmonary arterial hypertension

Abstract

Objectives:

To assess factors associated with adherence to phosphodiesterase type 5 inhibitors (PDE5Is) in the management of pulmonary arterial hypertension (PAH).