瑞替普酶溶栓治疗前后急性高危肺栓塞患者右心功能的变化  

Evaluation of right heart function after thrombolysis with reteplase in high-risk pulmonary embolism

作　　者：刘海涛[1] 何敬堂[1] 田涛[1] 檀巨宁[1] 闫利红[1] 李志娟[1] 邱志红[1] 张景[1] 

机构地区：[1]河北医科大学附属华北石油总医院呼吸内科,河北省任丘062552

出　　处：《中国医师杂志》2013年第12期1619-1621,共3页Journal of Chinese Physician

基　　金：中国石油华北油田科技项目（2010-HB-G23）

摘　　要：目的分析应用瑞替普酶（r—PA）溶栓治疗前后高危肺栓塞患者的右心功能的变化，以此评价疗效。方法选择2007年1月至2011年12月本院收治的应用瑞替普酶溶栓治疗的高危肺栓塞患者35例，观察治疗前、治疗后第1、14天患者右心功能的变化，住院期间出血副作用的发生率及病死率。结果溶栓治疗后第1、14天患者的右室左右径（RVD）、右室与左室左右径之比（RVD／LVD）、主肺动脉内径（PAD）、肺动脉收缩压（SPAP）均较治疗前明显下降，其差异有统计学意义（P〈0．05），但第1、14天时比较差异均无统计学意义（P〉0．05）。溶栓治疗后第1、14天时有效率分别为85．7％、91．4％，两者比较差异无统计学意义（P〉0．05）。溶栓后出血发生率为17．1％，治疗期间出血发生率为20％，住院期间病死率8．6％。结论瑞替普酶溶栓治疗可以迅速有效的改善高危肺栓塞患者的右心功能，并且安全有效。Objective To evaluate the thrombolytic effect of reteplase by observing the changes of right heart function indexes for patients with high-risk pulmonary embolism. Methods From January 2007 to December 2011, thrombolytic therapy with reteplase in 35 patients of high-risk pulmonary embolism .was observed before treatment, and on the lth day and 14th day after treatment in patients with right ventricular function changes, bleeding incidence and mortality during hospitalization. Results After the 1st and 14th day of thrombolytic therapy, right ventricular transverse diameter （ RVD）, RVD/left ventricular transverse diameter（ LVD）, pulmonary artery diameter （PAD）, and systolic pulmonary artery pressure （SPAP） were decreased obviously and the differences were significant （ P 〈 0. 05 ）. Between the value obtained after the 1 st and 14th day of treatment, no significant difference was found for the thrombolysis effective rate [ 85.7% vs 91.4% , P 〉0. 05] . The bleeding rate was 17.1% after thrombolysis. The bleeding rate during treatment was 20%. The in-hospital mortality rate was 8.6%. Conclusions The thrombolytic therapy with reteplase was safe and effective in the treatment of high-risk pulmonary embolism. Thrombolysis improved right ventricular function in patients with high-risk pulmonary embolism.

关 键 词：肺栓塞 急性病 血栓溶解疗法 组织型纤溶酶原激活物 治疗应用 心室功能 右 

分 类 号：R563.5[医药卫生—呼吸系统]