急性大面积肺栓塞应用不同剂量瑞替普酶溶栓治疗的血流动力学效果及安全性  

Hemodynamic changes and safety of different doses of reteplase in thrombolysis treatment of acute massive pulmonary embolism

作　　者：张明亮[1] 王爱萍[1] 尹鲁骅[1] 刘燕[1] 吴云[1] 张焕轶[1] 杜波[1] 

机构地区：[1]泰安市中心医院心内科,山东泰安271000

出　　处：《心脏杂志》2014年第5期550-553,共4页Chinese Heart Journal

基　　金：山东省科学技术厅立项资助(2008GG30002061)

摘　　要：目的:观察不同剂量瑞替普酶治疗急性大面积肺栓塞的血流动力学效果与安全性。方法:39例符合溶栓治疗的重症肺栓塞患者,24例(单剂量组)给予单次静推瑞替普酶18 mg溶栓,15例(双倍剂量组)给予瑞替普酶18 mg静推两次(两次间隔0.5 h),两组患者均进行24 h血流动力学监测,观察溶栓前后患者的总肺阻力变化及肺动脉压、心脏指数、生命体征变化、不良事件。结果:两组患者24 h内总肺阻力均持续下降,肺动脉压、心脏指数也均有改善。两组间无显著差别。但单剂量组不良事件发生率显著低于双倍剂量组(P<0.05)。结论:瑞替普酶适用于治疗急性大面积肺栓塞,单剂量应用在改善血流动力学指标上与双倍剂量疗效相当,且安全性上优于双倍剂量。AIM： To evaluate the hemodynamic changes and safety of reteplase in the treatment of acute massive pulmonary embolism. METHODS： Thirty-nine patients with severe pulmonary embolism selected for thrombolytic therapy were divided into two groups： 24 patients receiving intravenous reteplase （18 mg once） （single dose group） and 15 patients receiving intravenous reteplase 18 mg twice, with a 30-min interval （double dose group）. All patients were monitored for 24 h after treatment and hemodynamic indexes including total pulmonary resistance, pulmonary artery pressure, cardiac index, with vital sign changes and adverse events were recorded and compared between groups. RESULTS： The total pulmonary resistance in both groups decreased after treatment and pulmonary artery pressure and cardiac index were improved, with no significant difference between groups. Incidence of adverse events in the single dose group was significantly lower than that in the double dose group （P 〈 0. 05 ）. CONCLUSION： Reteplase can be used for treatment of acute massive pulmonary embolism. Although there is no therapeutic difference between single dose treatment and double dose treatment, single dose treatment is safer.

关 键 词：肺栓塞 瑞替普酶 溶栓 

分 类 号：R563.5[医药卫生—呼吸系统]