溶栓与单纯抗凝治疗急性次大面积肺栓塞的疗效及安全性

摘要

Objective:To explore the therapeutic effect and safety of thrombolysis and pure anticoagulation therapy in patients with acute submassive pulmonary embolism.Methods:A total of 6 3 patients with acute submassive pul-monary embolism were randomly divided into thrombolysis group (n=32)and pure anticoagulation group (n=31). Arterial blood gas index and right heart functional index changes of two groups were observed before treatment and after two-week treatment,and their therapeutic effects were compared and analyzed.Incidence of bleeding and thrombocytopenia were counted in two groups.Results:Compared with before treatment,there were significant improvements in arterial blood gas and right heart functional indexes after treatment in two groups,P<0.05 or <0.0 1;compared with pure anticoagulation group,there were significant rise in partial pressure of oxygen in artery [PaO2 , (77.8±7.3)mmHg vs.(83.4±8.7)mmHg],right ventricular anterior wall motion [RVAWM,(4.9± 1.7)mm vs.(5.8±2.2)mm];and significant descent in alveolar-arterial oxygen difference [P (A-a)O2 ,(23.1± 2.8)mmHg vs.(16.5±2.4)mmHg mmHg],pulmonary artery systolic pressure [PASP,(54.6±7.9)mmHg vs. (34.2 ± 7.5 )mmHg] in thrombolysis group,P<0.05 or <0.01. Total effective rate of thrombolysis group (100%)was significantly higher than that of pure anticoagulation group (80.6%),P=0.002. There were no signif-icant difference in incidence rates of bleeding and thrombocytopenia between two groups,P>0.05. Conclusion:Thrombolysis therapy can significantly lower pulmonary artery pressure and improve oxygenation and right ventricu-lar function indexes in patients with acute submassive pulmonary embolism.It may be a preferred recommendation for patients without contraindications.%目的：探讨溶栓与单纯抗凝治疗急性次大面积肺栓塞患者的疗效与安全性。方法：63例急性次大面积肺血栓栓塞症患者，被随机分为溶栓组（n＝32）与单纯抗凝组（n＝31）。观察两组治疗前与治疗2周后动脉血气指标及右心功能指标变化，进行疗效分析。统计两组出血、血小板减少发生情况。结果：治疗后两组动脉血气指标及右心功能指标较治疗前显著改善（P＜0.05或＜0.01）；与单纯抗凝组比较，溶栓组动脉血氧分压[PaO2，（77.8±7.3）mmHg比（83.4±8.7）mmHg]、右室前壁活动度[RVAWM，（4.9±1.7）mm比（5.8±2.2）mm]显著上升，肺泡-动脉血氧分压差[P （A-a）O2，（23.1±2.8）mmHg比（16.5±2.4）mmHg]、肺动脉收缩压[PASP，（54.6±7.9）mmHg比（34.2±7.5）mmHg]显著下降（P＜0.05或＜0.01）。溶栓组总有效率显著高于单纯抗凝组（100％比80.6％，P＝0.002）。两组出血发生率及血小板减少发生率无统计学差异（P＞0.05）。结论：溶栓治疗可显著降低急性次大面积肺栓塞患者的肺动脉压力，改善氧合及右室功能指标，无禁忌患者可考虑优先推荐。