【摘要】 目的 探讨华法令抗凝治疗肺血栓栓塞症(PTE)时尽快达到国际标准化比值(INR)在2~3之间时的剂量及方法。方法 分析94例接受华法令口服抗凝治疗的PTE患者的临床资料；比较起始量3mg组与6mg组在华法令治疗第3、5、10天时INR达标情况；计算达标者每日人均华法令用量。结果 94例患者中56例有明确达标剂量，占59.6%;所有达标者每日人均华法令用量为4.097mg;3mg组达标25例，6mg组达标22例；抗凝第3、5、10天时6mg组达标人数及百分比均明显高于3mg组(P<0.05)，两组达标时所用的华法令总量平均数皆为29mg左右；6mg组平均达标天数为第5~6天，3mg组为第8~9天(P<0.05)；随年龄增大华法令需求量下降;94例PTE患者在华法令抗凝期间无一例发生出血,6mg组有1例出现再栓塞。结论 使用6mg负荷量的给药方法可使PTE患者在第5~6天尽快达标同时又能避免早期再栓及出血；本组华法令平均个体维持量在4mg/d左右。

    【关键词】 肺栓塞;华法令；抗凝治疗

    The study of individual dosage of warfarin and its application in pulmonary thromboembolism

    LUO Hua,LIANG Ying,YANG Jing-hua,et al.

    ICU of Peking University Shenzhen Hospital，Shenzhen 518036，China

    【Abstract】 Objective To determine the best suitable maintenance dose of warfarin and normalize warfarin application in pulmonary thromboembolism (PTE) that can make international normalized ratio (INR) achieve therapeutic range (2 to 3 times the control) promptly. Methods From the data of ninety-four patients with PTE who received warfarin,the average dosage each day of patients with INR of 2 to 3 were calculated. On day 3,day 5 and day 10 after warfarin therapy, groups that initiated dose from 3mg and 6mg and INR achieved 2 to 3 were compared.Results Fifty-six of ninety-four patients with PTE achieved INR therapeutic range steadily,occupying 59.6% of all.In which,the average dosage of warfarin of each individual per day was 4.097 mg.25 patients in Group 3mg and 22 patients in Group 6mg achieved INR of 2 to 3.After warfarin therapy,the number and percent of patients with INR of 2 to 3 in Group 6mg was greater than patients in Group 3mg on day 3,day 5 and day 10 respectively(P<0.05).Both groups had same warfarin requirement,29 mg in average,before achieving INR therapeutic range.The day to achieve INR of 2 to 3 averaged 5~6 in Group 6mg and 8~9 in Group 3mg respectively(P<0.05).There was a inverse relationship between age and warfarin requirement.All of patients had no bleeding incident during warfarin therapy, one of thirty-four had recurrent thromboembolism in Group 6mg.Conclusion In early 5~6 days of therapy,a loading dose in initiation of warfarin therapy can achieve INR of 2 to 3 rapidly,without excess bleeding, and avoid the development of a potential hypercoagulable state.The maintenance dose of warfarin averaged 4mg per day. ......