急性大面积肺血栓栓塞患者应用延迟溶栓治疗临床疗效和安全性分析  

Analysis of Clinical Efficacy and Safety of Delayed Thrombolytic Methods in Patients with Acute Massive Pulmonary Throbembolism

作　　者：李德华 李敏 

机构地区：[1]中山市横栏医院内科,中山528478

出　　处：《血栓与止血学》2017年第2期186-189,共4页Chinese Journal of Thrombosis and Hemostasis

摘　　要：目的探索延迟溶栓治疗在急性大面积肺血栓栓塞(pulmonary thromboembolism,AMPTE)患者中的疗效和安全性。方法以本院2013年3月至2015年11月收治的进行溶栓治疗的AMPTE患者为研究对象,其中病程超过14 d的患者(A组)32例,病程在14 d以内的患者(B组)38例,回顾性分析其临床资料,记录两组患者的一般情况、病程、病因、D二聚体(D-D)、纤维蛋白降解产物(FDP)、超声心动图肺动脉收缩压(SPAP)等资料,比较两组患者治疗7 d后的B型钠尿肽(BNP)、SPAP、动脉血氧分压(Pa O_2)、动脉血二氧化碳分压(Pa CO_2)、CT肺动脉阻塞指数(CTI)、肌钙蛋白I(TNI)等指标,并比较两组患者的临床疗效和出血率等并发症。结果 A组有效率为75%,B组有效率为76%,组间无显著差异;两组患者治疗后与治疗前相比,BNP、SPAP、Pa O_2、Pa CO_2、CTI、TNI等指标均改善,P<0.05,A组患者治疗后与B组患者治疗后的实验室指标无显著差异,P>0.05;A组患者不同时间段治愈率和有效率无显著统计学差异;A组患者发生出血者9例,无死亡病例,B组患者8例发生出血,死亡1例,组间比较无显著统计学差异,P>0.05。结论AMPTE患者中,延迟溶栓治疗在病程超过14 d、有症状加重和D-D增高的患者中仍有疗效,安全可靠,对符合条件的患者应积极溶栓治疗。Objective To explore the clinical efficacy and safety of patients with acute massive pulmonary throbembolism （ AMPTE ） accepting delayed thrombolytic method. Methods A summary of 70 patients with AMPTE from March 2013 to November 2015,which were all given thrombolytic therapy,were set as our experimental objects, and 32 patients of these with duration over 14 days were classified into A group, and 38 patients with duration less than 14 days were chose as B group. Then A retrospectively analysis of these patients＇ clinical material were carried out, general situation, duration, etiological classification, D- dimer, fibrinogen degradation products（FDP） and pulmonary arterial systolic pressure of ultrasonic echocardiography （SPAP） were recorded, and brain natriuretic peptide （BNP） , SPAP, PaO2, PaCO2, CT pulmonary artery occlusion index（CTI） and Troponin I （TNI）in all patients after 7 days of thrombolytie therapy were compared, and the clinical efficacy and complications, such as hemorrhage and death, in the two groups were assessed. Results The efficacy of the two groups （A group was 75% , B group was 76% ） were not found notable diversion ; BNP, SPAP, PaO2 , PaCO2 , CTI and TNI after thrombolytic method in two groups got better then that before therapy,P 〈 0.05 ; While there were not statistically distinction of these laboratory indexes between A and B group after therapy, P 〈 0.05 ; In A group, the patients with hemorrhage were 9, and no death, while in B group,8 patients occurred hemorrhage, and 1 death, and no remarkable distinction were discovered between the two groups,P 〈 0.05. Conclusion AMPTE patients with duration over 14 days,worsening of symptoms and elevation of D-dimer still can benefit from delayed thrombolytic method, which were considered as safe and dependable,so patients meeting the qualifications should actively carry on delayed thrombolytic method.

关 键 词：延迟溶栓 肺血栓栓塞 急性大面积 

分 类 号：R563.5[医药卫生—呼吸系统]