阿替普酶联合肝素治疗急性中高危PTE的临床疗效及对患者动脉血气分析、心肌酶的影响  

Clinical efficacy of ateplase combined with heparin in the treatment of acute moderate-and high-risk pulmonary thromboembolism and its effects on arterial blood gas analysis and myocardial enzyme level

作　　者：方飞美 舒彩敏 赵飘飘 Fang Feimei;Shu Caimin;Zhao Piaopiao(Department of Respiratory and Critical Care Medicine,Dongyang People's Hospital,Dongyang 322100,Zhejiang Province,China)

机构地区：[1]东阳市人民医院呼吸与危重症医学科,东阳322100

出　　处：《中国基层医药》2023年第4期577-581,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省金华市科学技术研究计划(2021-4-141)。

摘　　要：目的探讨阿替普酶联合肝素治疗急性中高危肺血栓栓塞症(PTE)的临床疗效及对患者动脉血气分析和心肌酶的影响。方法回顾性选择东阳市人民医院2015年1月至2022年1月收治的急性中高危PTE患者78例为研究对象,按照治疗方法不同分为观察组(n=39)与对照组(n=39)。对照组给予肝素治疗,观察组在肝素基础上结合阿替普酶治疗。两组疗程7 d。比较两组疗效、治疗前后动脉血气分析、心肌酶及肺动脉压和右房室瓣环收缩期移位(TAPSE)变化。结果观察组总有效率(94.87%)高于对照组(76.92%),差异有统计学意义(χ^(2)=5.18,P<0.05)。观察组患者治疗后动脉二氧化碳分压(PaCO_(2))[(36.24±5.12)mmHg](1 mmHg=0.133 kPa)低于对照组(44.25±3.78)mmHg],而动脉氧分压(PaO_(2))[(78.82±5.1)mmHg]高于对照组[(71.23±4.89)mmHg],差异均有统计学意义(t=7.86、6.66,均P<0.05)。观察组患者治疗后乳酸脱氢酶(LDH)[(107.42±15.45)U/L]、肌酸激酶(CK)[(37.21±10.84)U/L]和肌酸激酶同工酶(CK-MB)(12.28±3.54)U/L]均低于对照组[(189.94±21.20)U/L、(65.42±6.57)U/L、(19.29±3.08)U/L],差异均有统计学意义(t=19.64、13.89、9.33,均P<0.001)。观察组患者治疗后肺动脉压[(32.24±3.86)mmHg]低于对照组[(37.79±5.17)mmHg],而TAPSE[(14.07±1.27)mm]高于对照组[(12.63±1.16)mm],差异均有统计学意义(t=5.37、5.22,均P<0.001)。结论阿替普酶联合肝素对急性中高危PTE患者疗效显著,且可显著改善患者动脉血气分析,降低心肌酶水平。Objective To investigate the clinical efficacy of alteplase combined with heparin in the treatment of acute moderate-and high-risk pulmonary thromboembolism and its effects on arterial blood gas analysis and myocardial enzyme level.Methods Seventy-eight patients with acute moderate-and high-risk pulmonary thromboembolism who received treatment in Dongyang People's Hospital from January 2015 to January 2022 were retrospectively included in this study.They were divided into observation(n=39)and control(n=39)groups according to different treatment methods.The control group was treated with heparin,while the observation group was treated with alteplase based on heparin.All patients were treated for 7 days.Clinical efficacy as well as arterial blood gas analysis,myocardial enzymes,pulmonary artery pressure,and tricuspid annular plane systolic excursion pre-and post-treatment were compared between the two groups.Results The total response rate in the observation group was significantly higher than that in the control group(94.87%vs.76.92%,χ^(2)=5.18,P<0.05).After treatment,the partial pressure of carbon dioxide in the observation group was significantly lower than that in the control group[(36.24±5.12)mmHg vs.(44.25±3.78)mmHg,1 mmHg=0.133 kPa,t=7.86,P<0.05].After treatment,the partial pressure of oxygen in the observation group was significantly higher than that in the control group[(78.82±5.1)mmHg vs.(71.23±4.89)mmHg,t=6.66,P<0.05].After treatment,lactate dehydrogenase,creatine kinase,and creatine kinase isoenzyme in the observation group were(107.42±15.45)U/L,(37.21±10.84)U/L,and(12.28±3.54)U/L,respectively,which were significantly lower than(189.94±21.20)U/L,(65.42±6.57)U/L,and(19.29±3.08)U/L in the control group(t=19.64,13.89,9.33,all P<0.001).After treatment,the pulmonary arterial pressure in the observation group was significantly lower than that in the control group[(32.24±3.86)mmHg vs.(37.79±5.17)mmHg,t=5.37,P<0.001].Tricuspid annular plane systolic excursion in the observation group was significan

关 键 词：肺栓塞 危险 血气分析 L-乳酸脱氢酶 肌酸激酶 组织型纤溶酶原激活物 肝素 

分 类 号：R563.5[医药卫生—呼吸系统]