Objective:To compare the effect of different dose recombinant tissue-type plasminogen activator (rt-PA) on acute pulmonary embolism (APE).Methods:105 APE patients treated in our hospital from January 2010 to May 2017 were selected and randomly divided into an observation group (n=53) and a control group (n=52).The patients in the observation group received 50 mg rt-PA,while those in the control group received 100 mg rt-PA.The clinical efficacy,right ventricular left and right diameter,main pulmonary diameter,pulmonary arterial systolic pressure,PaO2,arterial systolic pressure,D-dimer level and prognosis were compared.Resuits:The fight ventricular left and right diameter,main pulmonary diameter,pulmonary arterial systolic pressure and D-dimer level were decreased,while PaO2 and arterial systolic pressure were increased in both group at 60 min and 24 h post-treatment (P＜ 0.05),but the improvements at 60 min post-treatment in the control group were more significant compared with the observation group (P＜0.05).No significant differences were found between the two group after 24 h treatment with regard to above indexes (P＞ 0.05).The mortality and bleeding rate of the observation group were lower than those of the control group (P＜0.05).Conclusion:50 mg rt-PA had a similar efficacy with 100 mg rt-PA for APE,and lower mortality and bleeding rate.High dose rt-PA was more speedy.%目的:探讨不同剂量重组组织型纤溶酶原激活剂(rt-PA)治疗急性肺栓塞(APE)的疗效.方法:选取2010年1月至2017年5月广西医科大学第九附属医院收治的105例APE患者,按随机数字表法分为观察组(53例)和对照组(52例),观察组采用50 mg rt-PA治疗,对照组采用100 mg rt-PA治疗,比较两组临床疗效.观察患者治疗后右室左右径、主肺动脉径、肺动脉收缩压、动脉血氧分压(PaO2)、动脉收缩压、D-二聚体水平及预后情况.结果:治疗后60 min及治疗后24 h,两组右室左右径、主肺动脉径、肺动脉收缩压及D-二聚体水平均显著下降,PaO2、动脉收缩压均显著上升,与治疗前比较差异均有统计学意义(P＜0.05);且对照组治疗后60 min的右室左右径、主肺动脉径、肺动脉收缩压及D-二聚体水平明显低于对照组,PaO2、动脉收缩压明显高于观察组(P＜0.05).两组治疗总有效率、治疗后24 h右室左右径、主肺动脉径、动脉血气指标及D-二聚体水平比较差异无统计学意义(P＞0.05).观察组病死率及出血发生率均低于对照组(P＜0.05).结论:低剂量rt-PA治疗APE的临床疗效与100 mg rt-PA相当,虽然低剂量rt-PA起效较慢,但病死率及出血发生率较低,值得临床推广应用.
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