溶栓联合抗凝治疗次大面积肺栓塞患者的效果及安全性分析  

Efficacy and safety of thrombolysis combined with anticoagulant as a therapy for treating submassive pulmonary embolism

作　　者：郑静[1] ZHENG Jing(Department of Respiratory, Municipal Hospital of Taizhou, Taizhou 318000, China)

机构地区：[1]台州市立医院呼吸科,浙江台州318000

出　　处：《健康研究》2019年第2期212-215,共4页Health Research

摘　　要：目的研究次大面积肺栓塞患者治疗中采用溶栓联合抗凝治疗的效果及安全性。方法 67例急性次大面积肺栓塞患者按照所行的治疗方法分为溶栓抗凝联合治疗组(n=35)和单纯抗凝治疗组(n=32),分别采用阿替普酶溶栓治疗联合低分子肝素及华法林抗凝治疗、低分子肝素及华法林治疗;均治疗2周,并进行为期6个月的随访,比较两组患者血气分析指标、右心功能指标、治疗有效率及不良反应发生率。结果治疗2周后,两组患者的心率、呼吸频率、动脉血氧分压、动脉血二氧化碳分压、肺泡—动脉血氧分压差指标均改善且溶栓抗凝联合治疗组患者的各指标均优于单纯抗凝治疗组,差异均有统计学意义(P<0.05);治疗6个月后,两组患者的右心室内径、肺动脉压、三尖瓣反流压差指标均改善,且溶栓抗凝联合治疗组患者的心功能指标均优于单纯抗凝治疗组,差异均有统计学意义(P<0.05)。随访结束,溶栓抗凝联合治疗组患者的治疗总有效率(94.29%)高于单纯抗凝治疗组(75.00%),差异有统计学意义(χ~2=4.8965,P=0.0269);治疗期间,两组不良反应发生率差异无统计学意义(P>0.05)。结论溶栓联合抗凝治疗能降低次大面积肺栓塞患者右心负荷、提高治疗有效率,效果优于单纯抗凝治疗,且不增加不良反应发生率。Objective To evaluate the efficacy and safety of thrombolysis combined with anticoagulant as a therapy for treating submassive pulmonary embolism. Methods Firstly, 67 patients of submassive pulmonary embolism were divided into two groups in accordance with the treatment methods provided to them respectively, namely, group 1 ( n =35) to be treated with thrombolysis in combination with anticoagulan, group 2 ( n =32) to be treated with anticoagulant alone. Group 2 were treated with low molecular heparin and warfarin while group 1 were treated with alteplase in combination with low molecular heparin and warfarin. Both groups were subjected to medication course of 2 weeks and follow-up of 6 months. The blood gas analysis indicators, the cardiac function indicators, the rate of therapeutic efficacy and the rate of adverse reaction of the two groups were then evaluated and compared. Results After two weeks of treatment, the heart rate, the respiratory rate, the arterial partial pressure of oxygen, the arterial partial pressure of CO 2 , and alveolar-arterial O 2 tension difference of both groups improved considerably, with those of group 1 being better than those of group 2. The differences were statistically significant( P <0.05). After 6 months of treatment, the diameter of right ventricle, the pulmonary artery pressure, and the tricuspid regurgitation difference of both groups improved considerably, with those of group 1 being better than those of group 2. The differences were statistically significant ( P <0.05). The follow-ups indicated that the total effective rate of group 1 (94.29%) was higher than that of group 2 (75.00%). The difference was statistically significant (χ 2 =4.8965, P =0.0269). No significant difference was found between the two groups in the rate of incidence of adverse reactions in the course of medication ( P >0.05). Conclusions Thrombolysis combined with anticoagulant as a therapy for treating submassive pulmonary embolism can more effectively reduce the right cardiac load and heighten the r

关 键 词：次大面积肺栓塞 溶栓 抗凝 疗效 安全性 

分 类 号：R563.5[医药卫生—呼吸系统]