作者：徐露，方丹君，印春霞，陈璐

单位：

1.211166江苏省南京市，南京医科大学药学院　2.214500江苏省靖江市人民医院临床药学科　3.214500江苏省靖江市人民医院静配中心

Units：

1.College of Pharmacy, Nanjing Medical University, Nanjing 211166, China2.Clinical Pharmacy, Jingjiang People's Hospital, Jingjiang 214500, China3.Pharmacy Intravenous Admixture Service, Jingjiang People's Hospital, Jingjiang 214500, China

关键词：

心房颤动；心绞痛，不稳定型；达比加群酯；抗凝效果；安全性

Keywords：

Atrial fibrillation; Angina, unstable; Dabigatran etexilate; Anticoagulation effect; Safety

CLC：

R 541.75 R 541.4

DOI：

10.12114/j.issn.1008-5971.2023.00.222

Funds：

江苏省高等学校自然科学研究面上项目（19KJB350001）

摘要：

目的　探讨不同剂量达比加群酯在心房颤动合并不稳定型心绞痛患者抗凝治疗中的效果及安全性。方法　选取2021年12月至2022年10月靖江市人民医院收治的80例心房颤动合并不稳定型心绞痛患者，采用随机数字表法将其分成低剂量组与高剂量组，每组40例。所有患者入院后接受抗凝、抗血小板、介入治疗等常规治疗。高剂量组接受高剂量（150 mg/次）达比加群酯治疗，低剂量组接受低剂量（110 mg/次）达比加群酯治疗，两组连续治疗3个月。比较两组治疗前后凝血功能指标〔凝血酶时间（TT）、纤维蛋白原（Fib）、活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、D-二聚体（D-D）〕、血管功能指标〔颈-股动脉脉搏波传导速度（cf-PWV）、趾肱指数（TBI）、踝肱指数（ABI）〕、肝功能指标〔总胆红素（TBiL）、AST、ALT〕及出血事件、栓塞事件、药物不良反应发生情况。结果　两组治疗后TT、APTT、PT分别长于本组治疗前，D-D分别高于本组治疗前，低剂量组治疗后Fib高于本组治疗前，且低剂量组治疗后TT、APTT长于高剂量组，PT短于高剂量组，D-D高于高剂量组（P＜0.05）。两组治疗后cf-PWV分别慢于本组治疗前，TBI、ABI分别高于本组治疗前，且低剂量组cf-PWV慢于高剂量组，TBI、ABI高于高剂量组（P＜0.05）。两组治疗前后TBiL、AST、ALT比较，差异无统计学意义（P＞0.05）。低剂量组栓塞事件发生率、药物不良反应发生率低于高剂量组（P＜0.05）。结论　相比于高剂量达比加群酯，低剂量达比加群酯对心房颤动合并不稳定型心绞痛患者的抗凝效果更优，有助于改善患者血管功能，降低栓塞事件发生风险，且安全性较高。

Abstract：

　Objective To investigate the anticoagulant effect and safety of different doses of dabigatran ester in thetreatment of patients with atrial fibrillation and unstable angina pectoris. Methods A total of 80 patients with atrial fibrillationcomplicated with unstable angina pectoris admitted to Jingjiang People's Hospital from December 2021 to October 2022 wereselected and divided into low-dose group and high-dose group by random number table method, with 40 cases in each group. Allpatients received basic treatment such as anticoagulation, antiplatelet therapy, and interventional therapy after admission. Thehigh-dose group received high-dose (150 mg/time) dabigatran ester treatment, and the low-dose group received low-dose (110mg/time) dabigatran ester treatment. Both groups continuously treated for 3 months. The coagulation function indexes [thrombintime (TT) , fibrinogen (Fib) , activated partial thromboplastin time (APTT) , prothrombin time (PT) , D-dimer (D-D) ] , vascularfunction indexes [carotid-femoral pulse wave velocity (cf-PWV) , toe brachial index (TBI) , ankle brachial index (ABI) ] , liverfunction indexes [total bilirubin (TBiL) , AST, ALT] before and after treatment, and occurrence of bleeding events, embolismevents and adverse drug reaction were compared between the two groups. Results After treatment, TT, APTT, and PT in bothgroups were longer than those before treatment respectively, and D-D was higher than that before treatment respectively, FIB inthe low-dose group was higher than that before treatment (P < 0.05) . After treatment, TT, APTT in the low-dose group were longerthan those in the high-dose group, PT was shorter than that in the high-dose group, and D-D was higher than that in the high-dose group (P < 0.05) . After treatment, the cf-PWV of both groups was slower than that before treatment respectively, while theTBI and ABI were higher than those before treatment respectively (P < 0.05) . After treatment, cf-PWV of the low-dose group waslower than that of the high-dose group, while the TBI and ABI were higher than those of the high-dose group (P < 0.05) . Therewas no statistically significant difference in TBiL, AST, and ALT between the two groups before and after treatment (P > 0.05) .The incidences of embolism events and adverse drug reaction in the low-dose group were lower than those in the high-dose group(P < 0.05) . Conclusion Compared with high-dose dabigatran ester, low-dose dabigatran ester has better anticoagulant effect inthe treatment of patients with atrial fibrillation and unstable angina pectoris, which is helpful to improve the vascular function ofpatients, reduce the risk of embolism events, and has good safety.

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