阿替普酶对急性肺栓塞高危患者溶栓前后血浆N端B型尿钠肽前体水平的影响及疗效分析

摘要

目的 观察阿替普酶对急性肺栓塞(APE)患者溶栓治疗的临床疗效与溶栓前后血浆中N端B型尿钠肽前体(NT-proBNP)水平的变化,观察治疗后患者复发肺栓塞和慢性血栓栓塞性肺高血压(CTEPH)等并发症的情况.方法 选取我院2015年5月收治的符合溶栓条件的APE患者60例,对患者采用阿替普酶静脉溶栓治疗,记录患者溶栓前后的临床表现及并发症情况以及血浆NT-proBNP水平的变化,并对患者进行随访.平均随访时间为(14.29±9.21)个月.结果 与溶栓前比较,患者经溶栓治疗后血压有所上升,脉压差有增大,心率和呼吸有减慢,差异具有统计学意义(P＜0.05).APE患者的动脉血氧饱和度(S02),氧分压(P02)和二氧化碳分压(PC02)均出现了下降,肺泡动脉血压差上升.经药物溶栓治疗后患者S02、P02、PCO2均出上升,肺泡动脉血压差缩小,D二聚体迅速升高而NT-proBNP明显降低(P ＜0.001).患者经药物溶栓治疗后三尖瓣收缩期位移明显改善(P ＜0.001).60例患者中,21例溶栓前超声心动图显示右心大小正常,39例存在右心增大,溶栓治疗后右心缩小.溶栓过程更中无致死性大出血事件.患者出院后无复发及新发CTEPH的病例出现.结论 阿替普酶对APE患者进行溶栓治疗具有很好的临床疗效及安全性.%Objective To observe the clinical efficacy of alteplase in the treatment of thrombolytic therapy in patients with acute pulmonary embolism (APE)and the changes of N-terminal B-type natriuretic peptide (NT-proBNP)in plasma before and after thrombolysis.Patients with recurrent pulmonary embolism and chronic thrombotic pulmonary hypertension (CTEPH) and other complications after treatment.Methods 60 patients with APE were enrolled in our hospital in May 2015.Patients were treated with intravenous thrombolytic therapy with alteplase.The clinical manifestations and complications of patients with thrombolysis were recorded before and after thrombolysis.NT-proBNP levels were changed and follow-up were performed.The mean follow-up time was (14.29 ± 9.21) months.Results Compared with the thrombolysis,the blood pressure of the patients was increased after the thrombolytic therapy,the pulse pressure difference was increased,the heart rate and the breathing were slowed down,the difference was statistically significant(P ＜ 0.05).Patients with APE had a decrease in arterial oxygen saturation (SO2),oxygen partial pressure (PO2)and carbon dioxide partial pressure (PCO2),and an increase in alveolar arterial blood pressure.After treatment with thrombolytic therapy,the levels of SO2,PO2 and PCO2 were increased,the difference of alveolar arterial blood pressure was decreased,the D-dimer increased rapidly and NT-proBNP was significantly decreased(P ＜0.001).Patients with thrombolytic therapy after thrombolytic therapy significantly improved,the difference was statistically significant (P ＜ 0.001).Of the 60 patients,21 patients underwent echocardiography before thrombolysis showed normal fight ventficular size,39 had right ventricular enlargement,thrombolytic therapy after right ventricular reduction.Thrombolytic process more without fatal bleeding events.Patients with no pulmonary hypertension after discharge were not present in patients with newly diagnosed CTEPH.Conclusion Alteplase has a good clinical efficacy and safety in patients with APE.