瑞替普酶联合肝素钠治疗骨科围术期急性肺栓塞的效果观察

摘要

目的：探讨应用瑞替普酶联合肝素钠治疗骨科围术期急性肺栓塞(APE)的有效性和安全性。方法选取2012年1~6月就诊于本院骨科出现APE的38例患者为对照组，2012年7月~2013年12月就诊于本院骨科出现APE的40例患者为观察组。对照组患者给予吸氧、扩张肺血管、解热、镇痛、消炎及80 IU/kg的肝素钠抗凝治疗，观察组在对照组治疗基础上给予瑞替普酶进行溶栓治疗，18 mg/次，2次(两次给药时间间隔30 min)。观察比较两组的治疗效果，治疗前后各临床病理生理参数(心率、肺动脉平均压、血氧饱和度、动脉氧分压、二氧化碳分压、肺栓塞面积)的变化，出血并发症发生率。结果治疗前，两组患者各临床病理生理参数比较，差异无统计学意义(P>0.05)；治疗后，两组患者各临床病理生理参数均明显恢复，观察组心率、肺栓塞面积显著低于对照组(P<0.05)，肺动脉平均压、动脉氧分压、血氧饱和度、二氧化碳分压显著高于对照组(P<0.05)。观察组总有效率为92.5%，显著高于对照组的68.4%，差异有统计学意义(χ2=7.27，P=0.009)。观察组出血并发症发生率为12.50%，高于对照组的10.52%，但差异无统计学意义(χ2=0.074，P=1.00)。结论应用瑞替普酶联合肝素钠治疗骨科围术期APE能够明显改善患者的临床症状，疗效显著，安全性高，值得推广应用。%Objective To study the efficacy and safety of reteplase combined with heparin sodium in the treatment of perioperative acute pulmonary embolism (APE) in Department of Orthopedics. Methods 38 cases of patients with APE treated in the Department of Orthopedics of our hospital from January to June 2012 were selected as control group and 40 cases of patients with APE treated in the Department of Orthopedics of our hospital from July 2012 to December 2013 were selected as observation group.Patients in the control group were given with oxygen inhalation,pulmonary va-sodilator,antipyretic,analgesic,anti-inflammatory and 80 IU/kg of heparin anticoagulant therapy;while patients in the ob-servation group were given with reteplase thrombolytic therapy on the basis of control group,18 mg per time (the time interval was 30 min between two times).The clinical effect,clinical pathological and physiological parameters (heart rate, mean pulmonary arterial pressure,oxygen saturation and arterial partial pressure of oxygen and carbon dioxide partial pressure,pulmonary embolism area),the incidence of bleeding complications of the two groups were observed and com-pared. Results Before treatment,the clinical pathological and physiological parameters of the two groups had no signifi-cant difference (P<0.05);after treatment,the clinical pathological and physiological parameters of the two groups was sig-nificantly restored,the heart rate and the area of pulmonary embolism in the observation group was lower than that of the control group (P<0.05),and mean pulmonary arterial pressure,arterial oxygen partial pressure,saturation of blood oxygen and carbon dioxide partial pressure in the observation group was higher than that of the control group (P<0.05). The total effective rate in the observation group was 92.5%,higher than 68.4% of the control group (χ2=7.27,P=0.009). The incidence of bleeding complications in the observation group was 12.50%,higher than 10.52% of the control group, but the difference was not significant (χ2=0.074,P=1.00). Conclusion Reteplase combined with heparin sodium in the treatment of APE during the preoperative period in the Department of Orthopedics can obviously improve the clinical symptoms and has obvious curative effect and high safety,it is worthy of popularization and application.