达比加群与华法林用于非瓣膜性房颤老年患者抗凝治疗的有效性与安全性比较

达比加群与华法林用于非瓣膜性房颤老年患者抗凝治疗的有效性与安全性比较(论文14000字)
摘要：目的：比较达比加群与华法林用于合并高血压、稳定型冠心病、糖尿病、甲亢的非瓣膜性房颤老年患者抗凝治疗的有效性及安全性，以及孤立性房颤老年患者抗凝治疗的有效性及安全性。方法：选取2016年9月至2017年6月期间我院收治的5类非瓣膜性房颤老年患者各20例作为研究对象，随机将5类患者分为两组，分别为观察组及对照组，观察组给予达比加群110mg，每日2次，温水送服，对照组给予华法林3mg或2.5mg口服，每日1次，根据国际标准化比值INR调整剂量。各组均有患者10例，治疗1个月、3个月、6个月及1年后，各组患者均进行常规实验室检测、非致死出血事件与致死性事件评估及心脏彩超检查。结果：五类患者观察组与对照组之间尿常规、大便常规、肝功能（ALT、AST）和肾功能（Scr、BUN）、凝血酶原时间的差异无统计学意义（P>0.05）。五类患者两组均出现出血及死亡病例。五类患者华法林组的心房附壁血栓形成（2%）、脑栓塞（0%），与达比加群组心房附壁血栓形成（2%）、脑栓塞（0%）项目分别比较，不存在统计学意义（P<0.05）。可见，在抗凝治疗有效性上，达比加群与华法林相当。五类患者达比加群组皮肤黏膜瘀点瘀斑出血（2%）、眼底出血（4%）、大小便出血（6%）、牙龈出血（0%）、颅内出血（2%）、肺出血（0%），与华法林组皮肤黏膜瘀点瘀斑出血（6%）、眼底出血（6%）、大小便出血（4%）、牙龈出血（0%）、颅内出血（4%）、肺出血（0%），项目分别比较，存在统计学意义（P>0.05）。结论：达比加群与华法林对五类老年患者的抗凝有效性一致，但达比加群的安全性更高。
关键词：达比加群；华法林；非瓣膜性房颤；抗凝治疗；有效性；安全性
 
ABSTRACT: Objective: To compare the efficacy and safety of dabigatran with warfarin in anticoagulation therapy in elderly patients with non-valvular atrial fibrillation complicated by hypertension, stable coronary heart disease, diabetes mellitus, hyperthyroidism and isolated atrial fibrillation Effectiveness and safety of anticoagulant therapy in elderly patients. Methods: Totally 20 elderly patients with non-valvular atrial fibrillation in our hospital from September 2016 to June 2017 were selected as the research object. The 5 patients were randomly divided into two groups: the observation group and the control group , The observation group was given dabigatran 110mg, twice a day, warm water delivery, the control group given warfarin 3mg or 2.5mg orally, once daily, according to the international standardization ratio INR to adjust the dose. All patients had 10 cases in each group. After treatment for 1 month, 3 months, 6 months and 1 year, routine laboratory tests, non-fatal bleeding events and fatal events and echocardiography were performed in all groups. Results: The urinary routine, stool routine, hepatic function (ALT, AST), renal function (Scr, BUN) and prothrombin time in the five groups were not significantly different between the observation group and the control group (P> 0.05). Five groups of patients had bleeding and deaths in both groups. Atrial climacteric thrombosis (2%), cerebral embolism (0%), warfarin (2%) and cerebral embolism (0%) in the warfarin group were compared with those in the dabigatran group , There was no statistical significance (P <0.05). Can be seen in the effectiveness of anticoagulant therapy, dabigatran and warfarin quite. Five patients with dabigatran skin mucocutaneous ecchymosis (2%), fundus bleeding (4%), toilet bleeding (6%), gum bleeding (0%), intracranial hemorrhage (2%), lung Hemorrhage (0%) was associated with warfarin (6%), petechial ecchymosis (6%), retinal hemorrhage (6%), bleeding from the toilet (4%), bleeding from the gums (0% ), Pulmonary hemorrhage (0%), the items were compared, there is a statistically significant (P> 0.05). CONCLUSION: Dabigatran and warfarin are equally effective in anticoagulation in five elderly patients, but dabigatran is more safe.
Key words: warfarin; dabiga group; anticoagulant therapy; effectiveness; safety

目录
第一章前言    1
第二章研究对象与方法    2
2.1 研究对象    2
2.1.1 纳入标准    2
2.1.2 排除标准    3
2.2 研究方法    3
2.2.1 实验分组    3
2.2.2 用药方式    5
2.3 观察指标    5
2.3.1 有效性终点指标    5
2.3.2 安全性终点指标    5
2.4 统计学处理    5
第三章结果    6
3.1 华法林与达比加群抗凝治疗有效性比较分析    6
3.2 华法林与达比加群抗凝治疗安全性比较分析    6
3.2.1 临床化验指标比较    6
3.2.2 非致死出血事件比较    7
3.2.3 致死性事件及死亡比较    8
第四章讨论    10
4.1 华法林与达比加群对稳定型冠心病抗凝治疗有效性与安全性    10
4.2 华法林与达比加群对高血压有效性与安全性    11
4.3 华法林与达比加群对糖尿病有效性与安全性    12
4.4 华法林与达比加群对甲亢有效性与安全性    13
4.5 华法林与达比加群对孤立性房颤有效性与安全性    15
结论    17
参考文献    18