前列地尔联合瑞替普酶和低分子肝素对急性肺栓塞合并肺动脉高压患者的临床疗效  

The clinical efficacy of alprostadil combined with reteplase and low molecular heparin on the patients of acute pulmonary embolism with pulmonary hypertension

作　　者：王昕华[1] 吕蕾[1] 赵弘卿[1] 韩曙光[1] 

机构地区：[1]无锡市第二人民医院呼吸科,江苏无锡214000

出　　处：《临床急诊杂志》2016年第6期474-478,共5页Journal of Clinical Emergency

摘　　要：目的:探讨前列地尔联合瑞替普酶和低分子肝素对急性肺栓塞合并肺动脉高压患者的临床疗效。方法:将2011-03-2013-03我院收治的93例急性肺栓塞合并肺动脉高压的患者分为A组、B组和C组。A组给予前列地尔联合瑞替普酶和低分子肝素,B组给予瑞替普酶和低分子肝素,C组给予前列地尔和低分子肝素。评价患者的治疗效果、肺功能(FEV1及FEV1/FVC)、溶栓后血管再通率、肺动脉平均压,检测患者治疗前后血浆中的D-二聚体(D-D)、蛋白S(PS)、蛋白C(PC)、凝血调节蛋白(TM)、抗凝血酶Ⅲ(AT-Ⅲ)、纤溶酶原激活物抑制物-1(PAI-1)、组织型纤溶酶原激活物(t-PA)。结果:B组和C组的总有效率和和肺功能改善情况显著低于A组(P<0.05);治疗后B组和C组的动脉收缩压值和动脉氧分压值显著低于A组(P<0.05);治疗后B组和C组的肺动脉压力显著高于A组(P<0.05);治疗后B组和C组的PS、PC、D-D、PAT-1和TM含量显著高于A组(P<0.05)。结论:前列地尔联合瑞替普酶和低分子肝素的治疗方案治疗急性肺动脉栓塞合并肺动脉高压具有更加显著的治疗效果。Objective：To explore the clinical curative effect of alprostadil combined with reteplase and low molecular weight heparin on the paients of acute pulmonary embolism with pulmonary hypertension.Method：Nintythree patients of acute pulmonary embolism complicated with pulmonary hypertension treated in our hospital from March 2011 to March 2013 were divided into group A,B and C.Group A was treated with alprostadil combined with reteplase and low molecular weight heparin（LMWH）,group B was given reteplase and low molecular weight heparin（LMWH）,and group C was given alprostadil and low molecular weight heparin.The therapeutic effect,lung function（FEV1and FEV1/FVC）,recanalization rate after thrombolytic and mean pulmonary artery pressure of patients were evaluated.The plasma D-dimer（D-D）of patients before and after treatment,protein S（PS）,protein C（PC）,and clotting regulatory protein（TM）,antithrombin Ⅲ（AT-Ⅲ）,plasminogen activator plasminogen activator inhibitor-1（PAI-1）,and tissue type plasminogen activator plasminogen activator（t-PA）were measured.Result：In group B and C,the total efficiency and lung function improvement were significantly lower than that of group A（P〈0.05）;After treatment,the values of systolic blood pressure and arterial oxygen partial pressure of group B and C were significantly lower than that of group A（P〈0.05）;the pulmonary pressure in group B and group C after treatment were significantly higher than that of group A（P〈0.05）;PS,PC,D-D,PAI-1and TM in group B and C after treatment were significantly higher than that of group A（P〈0.05）.Conclusion：The therapy treatment of alprostadil combined with reteplase and low molecular weight heparin for the acute pulmonary embolism complicated with pulmonary artery hypertension has more significant therapeutic effect.

关 键 词：前列地尔 瑞替普酶 低分子肝素 急性肺栓塞 肺动脉高压 

分 类 号：R563.5[医药卫生—呼吸系统]