58例急性肺栓塞治疗方案的选择与评估  

Assessment of treatment regimens in 58 cases with acute pulmonary embolism

作　　者：梁瑛[1] 杨京华[1] 刘双[1] 丁少芳[1] 张向峰[1] 胡尚基[1] 高明哲[1] 

机构地区：[1]北京安贞医院呼吸科,100029

出　　处：《中华结核和呼吸杂志》2000年第4期235-238,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的探讨急性肺栓塞（APE）的最佳治疗方案。评估重组组织型纤溶酶原激活剂（rt-PA）和尿激酶（UK）2小时连续静脉溶栓法的可行性及临床疗效。方法58例经放射性核素肺灌注通气扫描（ECT）或选择性肺动脉造影（CPA）确诊为APE的患者，采用rt-PA或UK2小时连续静脉滴注法（简称2小时法）或UK小剂量每日1次3－7日法（简称Qd法）溶栓及单纯抗凝法，栓子切除法治疗。比较并分析不同治疗方案的临床疗效。结果溶栓治疗41例，无严重并发症，总有效率为78％，与抗凝组疗效比较差异有显著性（P＜0．001），其中2小时法总有效率为84％；病死率低于手术组、抗凝组。手术成功率为40％。APE治疗疗效受多重因素影响，治疗方案和溶栓时机为重要因素之一。结论rt-PA或UK2小时溶栓方法疗效显著、副作用少，对APE患者应及早溶栓，酌情扩大溶栓治疗窗，并依据血液动力学监测指标及时序贯抗凝治疗，可明显降低其病死率及致残率。Objective To explore the best regimen of treatment for acute pulmonary embolism(APE),and to evaluate the efficacy and safety of 2-h infusion of recombinant tissue-type plasminogen activator,Alteplase (rt-PA)and urokinase(Uk). Methods Fifty-eight patients with APE diagnosed by perfusion lung scanning (ECT) or angiography(CPA)were treated with different regimens: i. e. 2-h infusion of rt-PA or UK (2-h group);low doses of [JK for 3 ~ 7 days (Qd group); anticoagulants alone and thromboectomy.The results were compared.Results Of the 41 patients treated with thrombolytic therapy 78% showed improvement in lung perfusion scan and clinical presentation without severe adverse effects, the percentage was significantly highe than tha of the anticoagulant group (P < 0.001). The rate of improvement was 84% if thrombolytic therapy was given in 2 h. The mortality rate was lower than anticoagulants and thromboectomy group.The success rate of thromboectomy was 40%. Conclusions A 2 h regimen of rt-PA or UK showed reliable efficacy and safety for treatment of APE. The indication of thrombolytic therapy can be extended.Mortality and morbidity could be reduced if thrombolytic therapy followed by anticoagulation is applied as early as possible.

关 键 词：肺栓塞 溶栓疗法 RTPA 尿激酶 

分 类 号：R563.5[医药卫生—呼吸系统]