110例急性肺栓塞溶栓患者临床分析  

Clinical analysis of 110 cases of acute pulmonary embolism treated with thrombolysis

作　　者：高伟波[1] 石茂静[1] 窦丽稳[1] 张海燕[1] 杜昌[1] 郭杨[1] 朱继红[1] Gao Weibo;Shi Maojing;Dou Liwen;Zhang Haiyan;Du Chang;Guo Yang;Zhu Jihong(Emergency Department,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院急诊科,100044

出　　处：《中华急诊医学杂志》2020年第3期398-403,共6页Chinese Journal of Emergency Medicine

摘　　要：目的对110例急性肺栓塞(pulmonary embolism,PE)溶栓患者的临床特征、危险分层、溶栓治疗效果及预后进行临床分析,旨在提高临床诊治水平。方法回顾性收集北京大学人民医院2009年5月至2019年3月收治的110例肺栓塞溶栓患者的临床资料(年龄、性别、症状体征、血压、血气分析、出凝血、影像学)。纳入标准:符合高危、中高危诊断标准,患者临床资料完整;排除标准:中低危及低危组,患者临床资料不完整。依据入院时危险分层、出院时预后分组,采用χ^2检验、t检验或非参数检验,分析临床特征、血气分析、出凝血、出血并发症的组间差异,分析溶栓后影像学变化情况。结果110例患者中,男性49例,女性61例,年龄(65±16)岁。高危组12例,中高危组98例,高危组呼吸频率更快,血压、溶栓前PO2、SaO2更低(P<0.05)。109例患者予静脉重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rtPA)溶栓治疗,70例采用50 mg,39例采用100 mg。1例因阴道活动性出血,直接介入局部溶栓;另有5例行介入治疗,为溶栓后症状缓解不佳,行补救性介入治疗。存活102例,死亡8例(7.3%),其中高危组死亡3例(25.0%),中高危组死亡5例(5.1%);死亡组年龄高于存活组,心率、呼吸更快,溶栓前PO2、溶栓后PCO2更低。共发生22例溶栓相关出血,18例为轻微出血,4例为中重度出血,分别是脑出血、腹腔出血、消化道出血、阴道出血。rtPA 50 mg组出血13例/70例,rtPA100 mg组出血9例/39例,低剂量组出血比例显著较低(P<0.05)。结论溶栓治疗是急性高危PE的重要治疗方法,对于中高危PE溶栓疗效确定,中重度出血发生率低,安全性好。Objective To investigate the clinical characteristics,risk stratification,thrombolytic effects and prognosis of 110 patients with acute pulmonary embolism(PE)treated with thrombolysis.Methods The clinical data of 110 patients with PE admitted to Beijing University People's Hospital from May 2009 to March 2019 were retrospective analyzed.The clinical data including general information,symptoms and signs,blood pressure,artery blood gas,coaglulation,and radiography were collected.Inclusion criteria:high-risk and intermediate high-risk group.Exclusion criteria:intermediate low-risk and low-risk group.According to the prognosis and risk stratification,the patients were divided into survival group and non-survival group,high-risk group and intermediate high-risk group.The indicators above were compared between with χ^2 test,t test or nonparametric test where appropriate.Results Of the 110 patients with PE,49 patients were male and 61 female with an average age of 65±16 years old;and 12 patients were in the high-risk group and 98 in the intermediate high-risk group.The respiratory rate of the high-risk group was higher,and blood pressure,PO2,SaO2 before thrombolysis were more lower than the intermediate high-risk group(P<0.05).One hundred and nine patients were treated with systemic recombinant tissue plasminogen activator(rtPA),70 patients with 50 mg,and 39 patients with 100 mg.One patient,who was contraindicated to systemic thrombolysis(with active vagina bleeding),was treated with interventional local thrombolysis;another 5 patients treated with interventional local thrombolysis because the clinical symptom were not improved markedly.One hundred and two patients survived and 8 patients died,among which,3 patients were in the high-risk group and 5 in the intermediate high-risk group.The age,heart rate,respiration rate of the non-survival group were higher than those in the survival group,and the PO2 before thrombolysis,PCO2 after thrombolysis were lower(P<0.05).Bleeding complication were occurred in 22 patients:18 p

关 键 词：肺栓塞 急性 危险分层 溶栓 

分 类 号：R563.5[医药卫生—呼吸系统]