间断小剂量尿激酶溶栓治疗老年急性中高危肺栓塞的疗效和安全性

摘要

目的 探讨间断小剂量尿激酶(UK)溶栓治疗老年急性中高危肺栓塞的疗效和安全性.方法 将48例老年急性中高危肺栓塞患者随机分为UK组24例和重组组织型纤溶酶原激活剂(rt-PA)组24例.UK组给予UK每次10 000 U/kg静脉泵入,每天1次,共7天;rt-PA组给予阿替普酶50 mg入院当天静脉滴注,2h滴注完,后续均给予低分子肝素和法华林常规治疗.两组患者在治疗前和治疗后第8天、14天分别进行超声心动图、CT肺动脉造影检查及血气分析、D-二聚体和心肌肌钙蛋白Ⅰ(cTnⅠ)等检测,观察出血不良反应发生情况并进行比较.结果 与治疗前相比,治疗后第8天、14天UK组和rt-PA组舒张期右室内径(RV)/左室内径(LV)、收缩期肺动脉压(SPA)、动脉氧分压(PaO2)、D-二聚体、cTnⅠ均降低,动脉二氧化碳分压(PaCO2)均升高(但处于正常范围),差异均有统计学意义(P＜0.05),右心功能改善;但同一时间两组间上述指标比较,差异均无统计学意义(P＞0.05).治疗后第8天、14天UK组的总有效率(79.17％、87.50％)和rt-PA组(75.00％、91.67％)比较,差异均无统计学意义(P＞0.05).rt-PA组出血不良反应发生率(20.83％)高于UK组(8.33％,P＜0.05).结论 间断小剂量UK溶栓效果与rt-PA相当,但安全性更高.%Objective To explore the efficacy and safety of senile acute intermediate-high-risk pulmonary embolism treated by intermittent low dose urokinase(UK) thrombolysis.Methods Forty eight senile patients with acute pulmonary embolism were divided into the UK group(24 cases) and the recombinant tissue plasminogen activator(rt-PA) group(24 cases) randomly.The UK group was given UK 10 000 U/kg by intravenous pumping once a day for 7 days.The rt-PA group was given alteplase 50 mg by intravenous injection within 2 hours in the admission day,then regular treatment of low molecular weight heparin and warfarine were used in the two groups.Echocardiography,CT pulmonary angiography,arterial blood gas analysis,check of D-dimer and cardiac troponin Ⅰ(cTnⅠ) were conducted before treatment and 8,14 days after treatment in all patients.At the same time,adverse reaction of bleeding was observed.Results Compared with before treatment,right and left ventricular diastolic diameter ratio (RV/LV),systole pulmonary artery pressure(SPA),arterial partial pressure of oxygen (PaO2),D-dimer and cTnⅠ of the two groups all decreased 8 and 14 days after treatment,and arterial partial pressure of carbon dioxide increased which were all in normal with significant differance(P ＜ 0.05),which indicated that the right heart function improved,but above-mentioned indexes of the two groups in the same period were all unsignificantly different (P ＞ 0.05).Total effective rates of the UK group 8 and 14 days after treatment (79.17％,87.50％) and the rt-PA group(75.00％,91.67％) were all unsignificantly different(P ＞ 0.05).Ratio of adverse reaction of bleeding in rt-PA group(20.83％) was higer than that in the UK group(8.33％,P ＜ 0.05).Conclusion The effect of intermittent low dose UK thrombolysis is the same as rt-PA,but is safer than rt-PA.