下肢深静脉血栓并发肺栓塞的肺内血栓分布及抗凝治疗的临床观察  

Distribution of blood clots in lung and anticoagulation therapy in patients with lower extremity deep vein thrombosis combined acute pulmonary embolism

作　　者：郭治宇[1] 陆磊[1] 张浩[1] GUO Zhi-yu LU Lei ZHANG Hao.(Department of Vascular Surgery, Jin- hua Central Hospital , Jinhua , Zhefiang 321000, China)

机构地区：[1]金华市中心医院血管外科,浙江金华321000

出　　处：《中华全科医学》2017年第9期1493-1495,1585,共4页Chinese Journal of General Practice

基　　金：浙江省科技计划项目(2009F80002)

摘　　要：目的观察分析下肢深静脉血栓并发急性肺栓塞的肺内血栓分布及应用小剂量尿激酶溶栓联合抗凝治疗的临床效果。方法选取2014年1月—2016年1月金华市中心医院收治的80例下肢深静脉血栓并发急性肺栓塞患者,采用随机数字表法随机分为观察组(40例)和对照组(40例),对照组予以常规低分子肝素序贯华法林抗凝治疗,观察组在对照组治疗方案上加入小剂量尿激酶溶栓,分析比较治疗前血栓分布、治疗后5 d及2周时2组患者临床症状缓解、治疗前后实验室检查及下肢血栓治疗有效指标情况。结果 2组患者出现双肺3大分支栓塞最多,2大分支栓塞次之,2组之间的差异无统计学意义(P>0.05)。治疗后5 d观察组胸痛、呼吸困难缓解率明显高于对照组,差异具有统计学意义(均P<0.05)。治疗后2周2组在胸痛、呼吸困难缓解率之间的差异无统计学意义(P>0.05);咳嗽缓解率观察组明显高于对照组,差异具有统计学意义(P<0.05)。2组仅在治疗后D-Dimer之间的差异具有统计学意义(P<0.05);血小板(PLT)、国际化标准化比值(INR)、血清心房钠尿肽前体(NT-pro BNP)之间比较差异不具有统计学意义(均P>0.05)。对照组下肢血栓治疗有效率为34.98%,观察组为67.87%,2组间差异具有统计学意义(P<0.05)。结论下肢深静脉血栓并发急性肺栓塞的肺内血栓主要为双肺3大分支栓塞,2大分支栓塞次之;小剂量尿激酶溶栓联合抗凝治疗较单纯的抗凝治疗能在短时间内能有效缓解胸痛、呼吸困难等并发症,栓子消失效果显著,并且未增加远期出血风险,是一种高效、可靠的治疗方法。Objective To study the distribution of blood clots in lungs in patients with lower extremity deep vein thrombo- sis combined acute pulmonary embolism, and explore the clinical effect of small dose urokinase thrombolysis. Methods A total of 80 cases of lower extremity deep vein thrombosis combined acute pulmonary embolism in our hospital between January ,2014 and January ,2016 were enrolled and randomly divided into observation group（40 cases） and control group （40 cases）. The control group received anticoagulation with warfarin following by heparin therapy, while the observation group received additional small dose of urokinase thrombolysis treatment. The blood clots distribution in lung, laboratory test results and effective index for lower limb thrombus were compared before and after the treatment. The relief of clinical symptoms was observed at ds and d14. Results Thrombosis in 3 branches of pulmonary artery was common, following by 2 branches of pulmonary artery, there was no significant difference between the two groups （ P 〉 0.05 ）. After 5 days treat- ment, the remission rate of chest pain and dyspnea in the observation group was significantly higher than that in the control group,the difference was statistical signifieant（P 〈0.05）. Two weeks after the treatment,the remission rate of chest pain and dyspnea in the observation group was similar with the control group ,the difference was not statistical significant（ P 〉 0.05 ） ;the remission rate of cough response in the observation group was significantly higher than that in the control group, the difference was statistical significant（ P 〈 O. 05 ）. There was significant difference in the level of D-Dimer（ P 〈 0.05 ） , but not in the levels of PLT, INR and NT-proBNP（ P 〉 0.05 ） , between the two groups. The effective rate for lower extremities thrombosis treatment was 34.98% in the control group and 67.87% in the observation group, the difference between the two groups was statistical significant （ P 〈 0.05 ）

关 键 词：下肢静脉血栓 肺栓塞 尿激酶 溶栓 

分 类 号：R543.6[医药卫生—心血管疾病] R563.5[医药卫生—内科学]