29例急性肺栓塞临床观察及治疗研究  

Clinical characteristics and treatment of twenty-nine patients with acute pulmonary embolism

作　　者：刘双[1] 张维君[1] 梁瑛[1] 杨京华[1] 洪昭光[1] 张京岚[1] 胡尚基[1] 高明哲[1] 

机构地区：[1]首都医科大学附属北京安贞医院,100029

出　　处：《中华心血管病杂志》1999年第1期39-41,共3页Chinese Journal of Cardiology

摘　　要：目的分析急性肺栓塞的临床特点，观察溶栓抗凝治疗对急性肺栓塞的临床治疗效果。方法２９例肺栓塞患者根据放射性核素肺灌注通气检查、选择性肺动脉造影或超声心动图确诊。对其中２３例肺栓塞患者行静脉溶栓加抗凝治疗２９例次；６例肝素抗凝治疗，以临床及核素检查评价其治疗效果。结果男性患者中以年轻超力型发病者较高，女性患者以更年期以后发病明显增高。院外误诊率高达７５．９％。临床上以呼吸困难为主要表现者多见；尿激酶或重组组织型纤溶酶原激活剂（ｒｔ－ＰＡ）溶栓２９例次，总有效率为６５．５％。根据本组有限病例观察溶栓效果与栓塞的面积未见差异，而与发病开始到溶栓治疗的时间密切相关（Ｐ＜０．０５）。肝素抗凝６例，１例显效，２例有效，３例无效。结论应提高对急性肺栓塞的警惕性，减少误诊率；尿激酶或ｒｔ－ＰＡ对急性肺栓塞溶栓抗凝治疗安全有效，溶栓时间越早越好；对有溶栓适应证的患者应首选溶栓治疗。Objective To evaluate the efficacy of thromblytic therapy with urokinase (UK) orrecombinant tissue-type plaminogen activator (rt-PA) and anticoagulation therapy with heparin, and analyze theclinical characteristics of pulmonary embolism in patients with acute pulmonary embolism. Methods Thediagnosis of pulmonary embolism was based on the results of perfusion lung scanning, selective pulmonaryarteriography or ultrasound cardiogram. Twenty-three patients were treated by thrombolytic therapy, and six byanticoagulant therapy. Results Misdiagnostic rate before hospital admission was 75.9%. Twenty-three patientswith pulmonary embolism were treated by UK or rt-PA. The effective rate was 65.5%. The area of embolism wasnot related to the effectiveness of thrombolytic therapy, but the time starting the therapy was closely related toefficacy (P=0.03). Six patients weretreated by heparin, of who hepatin was effective in three. conclusion Itis important to enhance vigilance to acute pulmonary embolism, in order to decrease misdiagnostic rate. It iseffective and safe to administer UK or rt-PA intravenously in patients with acute pulmonary embolism. Thromboiytictherapy is the first choice and the earlier the better.

关 键 词：肺栓塞 溶栓疗法 

分 类 号：R563.505[医药卫生—呼吸系统]