急性肺血栓栓塞症溶栓及抗凝治疗多中心临床分析  

Multicenter clinical trial on the efficacy of thrombolytic therapy with urokinase and /or anticoagulant with low molecular weight heparin in acute pulmonary embolism

作　　者：程显声[1] 何建国[1] 高明哲[2] 陈光瑾[3] 李树花[4] 张中和[5] 赵鸣武[6] 周素敏 赵济文[8] 成立珠[9] 张珍祥[10] 陈玉林[11] 熊长明 

机构地区：[1]中国医学科学院,中国协和医科大学阜外心血管病医院心脏肺循环研究室,北京100037 [2]北京安贞医院 [3]天津医学院附属医院 [4]天津市胸科医院 [5]大连医科大学附属第一医院 [6]北京大学第三医院 [7]大连铁路中心医院 [8]解放军第309医院 [9]中日友好医院 [10]同济医科大学同济医院 [11]包头医学院附属第二医院

出　　处：《中华内科杂志》2002年第1期6-10,共5页Chinese Journal of Internal Medicine

摘　　要：目的　分析急性肺血栓栓塞症 (PTE)患者的临床资料并观察溶栓和抗凝治疗的疗效。方法　收集患者的病史 ,将确诊的 12 7例急性PTE患者分为 3组 ,A组患者予以尿激酶 2万U/kg溶于生理盐水 10 0ml中 ,静脉滴注 ,2h滴完。溶栓结束后 ,每 4h检测一次激活的部分凝血活酶时间或激活的全血凝固时间 ,待其恢复至基础值的 1 5～ 2 0倍以内 ,开始予以皮下注射低分子量肝素 0 4ml,每 12h一次 ,共 7d ,并重叠口服华法林 4～ 5d ,尔后单纯应用华法林 ,初使剂量为 3mg ,再根据国际标准化比率调整华法林剂量 ,直至INR达到 2～ 3。B组患者只用尿激酶静脉溶栓而不用低分子量肝素抗凝 ,并口服华法林 ,尿激酶及华法林的用法同A组。C组患者予以皮下注射低分子量肝素 0 4ml,每12h一次 ,共 7d ,并重叠口服华法林 ,华法林的用法同A组。治疗前后以临床表现及核素肺灌注显像或CT或肺动脉造影检查进行对比分析 ,观察其疗效。结果　 12 7例患者最常见的易患因素是深静脉血栓形成。临床症状以呼吸困难最为常见 ,其次是咳嗽、胸痛、咯血和晕厥。 70例用尿激酶溶栓和低分子量肝素抗凝治疗者 ,有效率为 90 0 %,有 2例患者发生轻度出血 ;31例单用尿激酶溶栓者 ,有效率为 77 4 %,有 1例患者发生轻度出血 ;2Objective To evaluate the efficacy of thrombolytic therapy with urokinase and/or anticoagulant with low molecular weight heparin in patients with acute pulmonary embolism.Methods 127 patients with documented acute pulmonary embolism were treated with different regimens: thrombolysis combined with anticoagulant theraphy in 70 cases, thrombolytic therapy alone in 31 cases and pure anticoagulant therapy in 26 cases.Results Dyspnea was the most common symptom(91.3%), then cougth (74.0%), chest pain(63.0%) and syncope (21.3%). As compared with pre-treatment in each group, there was significant improvement in respiratory rate, heart rate, partial pressure of oxygen in artery and partial pressure of carbon dioxide in artery. The effective rate of thrombolysis combined with anticoagulant therapy, thrombolytic therapy and anticoagulant therapy were 90.0%, 77.4% and 61.5%, respectively, the total effective rate of thrombolytic therapy was 86.1%.The best efficacy was demonstrated in patients within one week after onsent of symptoms. The therapy might be effective for cases with duration longer than two weeks after the onset of symptoms.Conclusion Thrombolytic therapy with urokinase combined with low molecular weight heparin is effective and safe for acute pulmonary embolism.

关 键 词：急性肺栓塞 血栓溶解疗法 溶栓治疗 尿激酶 抗凝治疗 低分子量肝素 PTE 

分 类 号：R563.5[医药卫生—呼吸系统]