急性肺栓塞合并深静脉血栓患者不同治疗方案临床分析  

Clinical analysis of different regimens on acute pulmonary thromboembolism with deep venous thrombosis

作　　者：郝敏[1] 佟丽[1] 程兆忠[1] 

机构地区：[1]青岛大学医学院附属医院(东区)呼吸科,266101

出　　处：《国际呼吸杂志》2012年第8期578-581,共4页International Journal of Respiration

摘　　要：目的通过分析急性中危肺血栓栓塞症合并下肢深静脉血栓形成患者的临床资料，分析不同治疗方案的治疗效果，探讨对该类人群合理的治疗方案。方法采用回顾性研究方法，收集2006年1月至2011年5月于我院连续收治、临床疑诊肺栓塞并经CT肺动脉造影及心脏彩超、下肢血管超声或CT血管造影确诊为急性中危肺栓塞合并下肢深静脉血栓患者的临床资料。根据治疗方案的不同分为单纯抗凝组和溶栓联合抗凝组。结果73例急性中危肺栓塞合并下肢深静脉血栓患者最主要的危险因素是外伤手术（50．7％），其次是下肢静脉曲张（35．6％）；最常见的临床表现是呼吸困难（95．9％），最常见的体征是双下肢不对称肿胀（79．5％）；治疗前两组患者年龄、性别及临床表现分布差异无统计学意义（P〉0．05）；两组D-二聚体及心超估测肺动脉收缩压（PASP）明显升高，动脉血氧分压（PaO2）明显下降（P〈0．05），但两组之间指标差异无统计学意义（P〉0．05）；治疗后两组D-二聚体及PaO2较治疗前均有明显改善，但溶栓联合抗凝组PASP明显低于单纯抗凝组（P〈0．05）。所有患者治疗后未出现重要部位出血。结论溶栓联合抗凝治疗能够明显改善患者肺动脉收缩压，进而改善患者右心功能和临床症状，疗效显著优于单纯抗凝治疗。Objective To evaluate the efficacy of thrombolytic therapy and/or anticoagulantion with low molecular weight heparin in patients with acute intermediate pulmonary thromboembolism （PTE） with deep venous thrombosis （DVT）. Methods This article was a retrospective study of 73 patients date from January 2006 to May 2011 with computed tomographic pulmonary angiography and ultrasonic diagnosed acute intermediate PTE＋DVT. All the patients with documented acute intermediate PTE＋ DVT were treated with two different regimens：thrombolysis combined with anticoagulantion therapy in 39 cases, pure anticoagulantion therapy in 34 cases. The D-dimer, blood gas analysis, pulmonary artery systolic pressure （PASP） were compared between the two groups. The diagnosis and treatment processes accorded with the guideline. Results The most common risk factor was trauma and surgery （50.7%）, then varicose vein （35.6%）. Dyspnea was the most common symptom （95.9%）, crura asymmetrically swollen was the most common sign （79.5 % ）. The two groups had no difference in symptoms, sex and age composition （ P 〉 0.05）. The D-dimer and PASP of both groups significantly elevated, while PaO2 decreased （P 〈0.05）, and the two groups showed no difference （P 〉0.05）. After treatment, the thrombolysis plus anticoagulantion group was significantly better than the pure anticoagulantion group （ P 〈0.05）. Major bleeding was not documented. Conclusions Thrombolytic therapy combined with low molecular weight heparin is much more effective for acute intermediate PTE^-DVT than anticoagulation alone.

关 键 词：中危肺栓塞 深静脉血栓形成 溶栓 抗凝 肺动脉收缩压 心脏超声 

分 类 号：R563.5[医药卫生—呼吸系统]