不同再通治疗方式对肺栓塞相关性休克的疗效比较  

Effects of different recanalization therapy on pulmonary embolism associated shock

作　　者：何斌[1] 陈旭峰[1] 李琳[1] 张劲松[1] 

机构地区：[1]南京医科大学第一附属医院急诊科

出　　处：《实用休克杂志（中英文）》2017年第1期42-45,共4页Journal of Practical Shock

摘　　要：目的比较尿激酶静脉溶栓和介入碎栓取栓治疗对肺栓塞相关性休克的疗效差异。方法回顾性分析2008年10月至2015年08月期间南京医科大学第一附属医院收治的急性肺栓塞患者，选取其中存在休克的高危肺栓塞病例共43例。根据初始再通方式为尿激酶溶栓或介入碎栓取栓治疗，分为溶栓组（n=25）和介入组（n=18）。比较两组患者再通治疗12h的血流动力学指标，包括平均动脉压、心率、血管活性药物使用率、休克纠正率，以及30d内的严重出血率和非严重出血率。结果两组患者于再通治疗12h的血压、血管活性药物使用率、休克纠正率无明显差异（P〉0．05），而介入组的心率明显低于溶栓组（P〈0．05）；与溶栓组相比，介入组30d严重出血率和非严重出血率均低于溶栓组（P〈0．05）。结论尿激酶溶栓和介入碎栓取栓治疗均可较好的纠正肺栓塞患者的休克状态，效果相似。而在出血风险方面，介入治疗较溶栓治疗明显降低。Objective To compare the efficacy of urokinase thrombolysis and interventional thrombeetomy in the treatment of pulmonary embolism associated shock. Methods In a retrospective study, a total of 43 acute pulmonary embolism patients with shock were admitted to the First Affiliated Hospital of Nanjing Medical University between October, 2008 and Augest, 2015. The patients were divided into the throm- bolysis group （n =25 ） and the intervention group （n = 18 ） according to the initial reeanalization mode. He- modynamic parameters （ average arterial pressure, heart rate, vasoactive drugs application rate and the shock correction rate） at 12h after reeanalization, and the incidence of hemorrhage in 30 days were compared between two groups. Results There was no significant difference between two groups in the average arterial pressure, vasoactive drugs application rate and shock correction rate at 12 h after recanalization （P 〉 0.05 ）. However, the heart rate of the intervention group was significantly lower than that of the thrombolysis group （ P 〈0. 05 ）. Compared with the thrombolysis group, the severe bleeding rate and non severe bleeding rate of the intervention group were significantly decreased in 30d （P 〈0.05）. Conclusions Both urokinase thrombolysis and interventional thrombeetomy can correct the shock of pulmonary embolism patients. However the bleeding risk of interventional therapy was significantly lower than that of thrombolytic therapy.

关 键 词：急性肺栓塞 休克 尿激酶 出血率 

分 类 号：R563.5[医药卫生—呼吸系统]