张小玲　邱志维　岳文婧

【摘要】 目的：探索利伐沙班對老年房颤合并急性冠脉综合征（ACS）患者心血管不良事件的影响，为未来临床治疗提供依据。方法：选择2017年10月-2019年10月在惠州市第一人民医院治疗的86例老年房颤合并ACS患者，采用随机数字表法将其分为A组和B组，各43例。两组均采用双联抗血小板治疗，在此基础上，A组加用传统抗凝药物华法林治疗，B组加用利伐沙班治疗。对比两组凝血功能指标、炎症指标的变化和治疗期间心血管不良事件及出血事件发生情况。结果：治疗3个月，两组凝血酶时间（TT）、活化部分凝血酶时间（APTT）、凝血酶原时间（PT）均长于治疗前，纤维蛋白原（FIB）、D-二聚体（D-D）水平均低于治疗前，且B组TT、APTT、PT均长于A组，FIB、D-D水平均低于A组，差异均有统计学意义（P<0.05）。治疗3个月，两组血清肿瘤坏死因子-α（TNF-α）、内皮素-1（ET-1）及C反应蛋白（CRP）水平均低于治疗前，且B组上述指标水平均低于A组，差异均有统计学意义（P<0.05）。B组治疗期间不良心血管事件发生率为6.98%，低于A组的27.91%，差异有统计学意义（P<0.05）。B组治疗期间出血发生率为4.65%，低于A组的18.60%，差异有统计学意义（P<0.05）。结论：利伐沙班治疗可调节老年房颤合并ACS患者的凝血功能指标，降低心血管不良事件发生率。

【关键词】 房颤 急性冠脉综合征 利伐沙班

Effect of Rivaroxaban on Adverse Cardiovascular Events in Elderly Patients with Atrial Fibrillation and Acute Coronary Syndrome/ZHANG Xiaoling， QIU Zhiwei， YUE Wenjing. //Medical Innovation of China， 2021， 18（23）： 0-030

[Abstract] Objective： To explore the effect of Rivaroxaban on adverse cardiovascular events in elderly patients with atrial fibrillation and acute coronary syndrome （ACS）， and to provide a basis for future clinical treatment. Method： A total of 86 patients with atrial fibrillation combined with ACS in the First People’s Hospital of Huizhou from October 2017 to October 2019 were selected， the patients were divided into group A and group B by random number table method， with 43 cases in each group. Both groups were treated with dual antiplatelet therapy， on this basis， Warfarin was added to group A， and Rivaroxaban was added to group B. The changes of coagulation function indexes， inflammatory indexes， cardiovascular adverse events and bleeding events during treatment were compared between the two groups. Result： After 3 months of treatment， the thrombin time （TT）， activated partial thrombin time （APTT） and prothrombin time （PT） of the two groups were longer than those before treatment. fibrinogen （FIB） and D-dimer （D-D） levels were lower than those before treatment， and TT， APTT， PT of group B were longer than those of the group A， FIB， D-D levels were lower than those of group A， the differences were statistically significant （P<0.05）. After 3 months of treatment， the levels of serum tumor necrosis factor-α （TNF-α）， endothelin-1 （ET-1） and C-reactive protein （CRP） in the two groups were lower than those before treatment， and the above-mentioned index levels in group B were lower than those of the group A， the differences were statistically significant （P<0.05）. The incidence of adverse cardiovascular events during treatment in group B was 6.98%， which was lower than 27.91% in group A， the difference was statistically significant （P<0.05）. During treatment， the incidence of bleeding in group B was 4.65%， which was lower than 18.60% in group A， the difference was statistically significant （P<0.05）. Conclusion： Rivaroxaban treatment can adjust the coagulation function indexes of elderly patients with atrial fibrillation and ACS， and reduce the incidence of adverse cardiovascular events.

[Key words] Atrial fibrillation Acute coronary syndrome Rivaroxaban

First-author’s address： Huizhou First People’s Hospital， Huizhou 516000， China

doi：10.3969/j.issn.1674-4985.2021.23.007

随着社会人口的老龄化，老年房顫合并急性冠脉综合征（acute coronary syndrome，ACS）患者的数量也日见增多。随着病情进展，该病患者常会出现脑卒中、心肌再梗死等症状，给患者的生活带来了严重的影响，故寻找安全的治疗措施非常重要[1-2]。利伐沙班作为一种高效的FXa抑制剂，能够稳定药代动力学，不会与食物、药物发生相互作用，其可作为一种理想的口服抗凝药物[3]。……