目的 探討溶栓與抗凝治療對(duì)急性次大面積肺血栓栓塞癥( PTE) 患者的療效與安全性。方法 回顧分析符合入選標(biāo)準(zhǔn)的84 例次大面積PTE 患者的臨床資料, 溶栓組49 例, 單純肝素抗凝組( 抗凝組) 35 例, 以治愈、顯效、進(jìn)步、無(wú)效、惡化和死亡6 級(jí)判斷標(biāo)準(zhǔn)進(jìn)行療效評(píng)價(jià), 以治愈+ 顯效+ 進(jìn)步為有效, 計(jì)算有效率, 以惡化+ 死亡計(jì)算嚴(yán)重事件發(fā)生率, 統(tǒng)計(jì)出血并發(fā)癥。結(jié)果 溶栓組臨床有效率為81. 6%, 顯著高于抗凝組的54. 3% ( P = 0. 007) 。溶栓組惡化1 例, 無(wú)死亡病例
抗凝組惡化4 例, 死亡1例, 兩組嚴(yán)重事件發(fā)生率分別為2. 0% 和14. 3% , 差異有統(tǒng)計(jì)學(xué)意義( P = 0. 032)
溶栓組和抗凝組出血發(fā)生率分別為20. 4% 和14. 3% , 差異無(wú)統(tǒng)計(jì)學(xué)意義( P >
0. 05) , 且主要為皮下或穿刺點(diǎn)出血, 兩組均未出現(xiàn)嚴(yán)重出血病例。結(jié)論 急性次大面積PTE 患者, 在無(wú)溶栓絕對(duì)禁忌證的情況下, 可首選溶栓治療, 以迅速逆轉(zhuǎn)右心功能不全, 改善患者臨床癥狀和近期預(yù)后。
肺血栓栓塞癥; 右室功能不全; 溶栓療法; 抗凝療法
引用本文： 宗華,朱光發(fā),梁瑛. 溶栓與抗凝治療急性次大面積肺血栓栓塞癥的療效和安全性比較. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2009, 09(1): 48-51. doi: 復(fù)制
版權(quán)信息： ?四川大學(xué)華西醫(yī)院華西期刊社《中國(guó)呼吸與危重監(jiān)護(hù)雜志》版權(quán)所有，未經(jīng)授權(quán)不得轉(zhuǎn)載、改編
| 1. | 中華醫(yī)學(xué)會(huì)呼吸病分會(huì). 肺血栓栓塞癥的診斷與治療指南( 草案) . 中華結(jié)核和呼吸雜志, 2001, 24: 259-264. |
| 2. | Buller HR, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest, 2004, 126 :S401-S428. |
| 3. | Thabut G, Logeart D. Thrombolysis for Pulmonary Embolism in Patients With Right Ventricular Dysfunction Con. Arch Intern Med,2005, 165, 2200-2203. |
| 4. | Goldhaber SZ. Thrombolytic Therapy for Patients With Pulmonary Embolism Who Are Hemodynamically Stable But Have Right Ventricular Dysfunction Pro. Arch Intern Med, 2005, 165, 2197-2199. |
| 5. | 張?zhí)N, 楊媛華, 龐寶森, 等. 急性肺血栓栓塞患者血清轉(zhuǎn)氨酶的變化. 中華急診醫(yī)學(xué)雜志, 2007, 16: 859-863. |
| 6. | 康健, 王辰, 陸慰萱, 等. 專家討論會(huì): 肺血栓栓塞癥. 中國(guó)實(shí)用內(nèi)科學(xué)雜志, 2006, 26 : 1457 -1465. |
| 7. | Kreit JW. The impact of right ventricular dysfuction on the prognosis and therapy of normotensive patients with pulmonary embolism. Chest, 2004, 125: 1539-1545. |
| 8. | 楊京華, 梁瑛, 胡尚基, 等. 急性肺血栓栓塞癥溶栓治療的遠(yuǎn)期觀察. 中華結(jié)核呼吸雜志, 2001, 24: 753. |
| 9. | 何建國(guó), 程顯聲, 高明哲, 等. 全國(guó)21 家醫(yī)院急性肺栓塞診治情況的調(diào)查分析. 中華醫(yī)學(xué)雜志, 2001, 81: 1490-1492. |
| 10. | Kucher N, Rossi E, De Rosa M, et al. Prognostic role of echocardiography among patients with acute pulmonary embolism and preserved systemic arterial pressure. Arch Intern Med, 2005, 165: 1777-1781. |
| 11. | Schoepf UJ, Kucher N, Kipfmueller F, et al. Right ventricular enlargement on chest computed tomography: a predictor of early death in acute pulmonary embolism. Circulation, 2004, 110: 3276-3280. |
| 12. | Konstantinides S, GeibelA, Heusel G, et al. Heparin plus alteplase compered with heparin alone in patients with submassive-pulmonary embolism. N Engl JMed, 2002, 347: 1143-1150. |
| 13. | Wan S, Quinlan DJ, Agnelli G, et al. Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: a meta-analysis of the randomized controlled trials. Circulation, 2004 , 110 :744 -749. |
| 14. | Hamel E, Pacouret G, Vincentelli D, et al. Thrombolysis or heparin therapy in massive pulmonary embolism with right ventricular dilation.Chest, 2001, 120: 120-125. |
| 15. | Mikkola KM, Patel SR, Parker JA, et al. Increasing age is a major risk factor for hemorrhagic complications after pulmonary embolism thrombolysis. Am Heart J, 1997, 134: 69-72. |
- 1. 中華醫(yī)學(xué)會(huì)呼吸病分會(huì). 肺血栓栓塞癥的診斷與治療指南( 草案) . 中華結(jié)核和呼吸雜志, 2001, 24: 259-264.
- 2. Buller HR, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest, 2004, 126 :S401-S428.
- 3. Thabut G, Logeart D. Thrombolysis for Pulmonary Embolism in Patients With Right Ventricular Dysfunction Con. Arch Intern Med,2005, 165, 2200-2203.
- 4. Goldhaber SZ. Thrombolytic Therapy for Patients With Pulmonary Embolism Who Are Hemodynamically Stable But Have Right Ventricular Dysfunction Pro. Arch Intern Med, 2005, 165, 2197-2199.
- 5. 張?zhí)N, 楊媛華, 龐寶森, 等. 急性肺血栓栓塞患者血清轉(zhuǎn)氨酶的變化. 中華急診醫(yī)學(xué)雜志, 2007, 16: 859-863.
- 6. 康健, 王辰, 陸慰萱, 等. 專家討論會(huì): 肺血栓栓塞癥. 中國(guó)實(shí)用內(nèi)科學(xué)雜志, 2006, 26 : 1457 -1465.
- 7. Kreit JW. The impact of right ventricular dysfuction on the prognosis and therapy of normotensive patients with pulmonary embolism. Chest, 2004, 125: 1539-1545.
- 8. 楊京華, 梁瑛, 胡尚基, 等. 急性肺血栓栓塞癥溶栓治療的遠(yuǎn)期觀察. 中華結(jié)核呼吸雜志, 2001, 24: 753.
- 9. 何建國(guó), 程顯聲, 高明哲, 等. 全國(guó)21 家醫(yī)院急性肺栓塞診治情況的調(diào)查分析. 中華醫(yī)學(xué)雜志, 2001, 81: 1490-1492.
- 10. Kucher N, Rossi E, De Rosa M, et al. Prognostic role of echocardiography among patients with acute pulmonary embolism and preserved systemic arterial pressure. Arch Intern Med, 2005, 165: 1777-1781.
- 11. Schoepf UJ, Kucher N, Kipfmueller F, et al. Right ventricular enlargement on chest computed tomography: a predictor of early death in acute pulmonary embolism. Circulation, 2004, 110: 3276-3280.
- 12. Konstantinides S, GeibelA, Heusel G, et al. Heparin plus alteplase compered with heparin alone in patients with submassive-pulmonary embolism. N Engl JMed, 2002, 347: 1143-1150.
- 13. Wan S, Quinlan DJ, Agnelli G, et al. Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: a meta-analysis of the randomized controlled trials. Circulation, 2004 , 110 :744 -749.
- 14. Hamel E, Pacouret G, Vincentelli D, et al. Thrombolysis or heparin therapy in massive pulmonary embolism with right ventricular dilation.Chest, 2001, 120: 120-125.
- 15. Mikkola KM, Patel SR, Parker JA, et al. Increasing age is a major risk factor for hemorrhagic complications after pulmonary embolism thrombolysis. Am Heart J, 1997, 134: 69-72.