小剂量尿激酶溶栓治疗中危急性肺栓塞的疗效

摘要

目的：评价小剂量尿激酶溶栓治疗中危急性肺栓塞的疗效及安全性。方法将72例中危急性肺栓塞患者随机分为尿激酶溶栓治疗组(A 组)和抗凝治疗组(B 组),每组36例患者。A 组给予小剂量尿激酶溶栓治疗后序贯为抗凝治疗；B 组给予单纯抗凝治疗(方法同 A 组后续抗凝方案),治疗1周后复查两组肺动脉压力、心脏彩色超声、CT 肺动脉造影(CTPA)、血气分析、脑钠肽、肌钙蛋白等指标,评价小剂量尿激酶溶栓疗效,观察两组治疗1周后鼻腔、阴道、内脏出血及死亡情况,以评价治疗安全性。结果 A 组总有效率达88.9%(32/36),明显高于 B 组的总有效率75.0%(27/36)(P <0.05)；治疗后的动脉血气分析中 PaO2的升高及肺动脉收缩压的降低,A 组明显优于 B 组(P <0.05)。结论小剂量尿激酶溶栓治疗中危急性肺栓塞患者,疗效好且安全性较高。%Objective To evaluate the efficacy and safety of low dose urokinase thrombolytic therapy for intermediate risk acute pulmonary thromboembolism. Methods Seventy-two medium risk of pulmonary thromboembolism patients were randomly divided into thrombolytic therapy group (group A) and anticoagulant therapy group (group B),each group 36 patients.Group A was given a small dose of urokinase treatment and then sequential anticoagulation therapy;group B was given anticoagulant therapy merely(by the same way like A group). One week after the treatment,SPAP,color Doppler ultrasound,CTPA,blood gas analysis,BNP and TNI were reviewed in two groups to evaluate the curative effect.Nose bleeding,vaginal and visceral bleeding as well as death were observed to estimate the safety between two groups.Results The total effective rate of low-dose urokinase thrombolytic therapy group (88.9%,32/36)was significantly higher than that of anticoagulant group (75.0%,27/36) (P <0.05).After the treatment,the elevation of PaO 2 included in intra-arterial blood gas and reduction of pulmonary artery systolic pressure in low-dose thrombolytic therapy group was significantly better than anticoagulant group(P <0.05).Conclusion Low dose urokinase thrombolytic has better curative effect and higher security in intermediate risk acute pulmonary thromboembolism.