摘要
目的研究注射用重组人组织型纤溶酶原激酶衍生物(reteplase,r-PA)静脉泵注对急性肺栓塞(pulmonary embolus,PE)溶栓治疗的临床效果及安全性。方法选取我院2012年1月—2014年4月符合溶栓指征的急性PE患者76例,根据溶栓用药种类和给药方法的不同分为r-PA静脉泵注组17例、r-PA静脉推注组32例和尿激酶组27例。r-PA静脉泵注组应用注射用r-PA 18 mg加0.9%氯化钠注射液50 ml 2 h内缓慢静脉泵入;r-PA静脉推注组应用注射用r-PA两次缓慢静脉推注,每次18 mg,推注间隔30 min,每次推注时间≥2 min;尿激酶组予尿激酶20 000 U/kg加0.9%氯化钠注射液100 ml 2 h内静脉滴注。溶栓治疗后常规予华法林及低分子肝素抗凝。观察比较溶栓治疗前及治疗后7 d肺动脉再通率、动脉血氧分压(Pa O2)及肺动脉平均压的变化以评价溶栓治疗效果,并观察各组溶栓后并发症发生情况和30 d病死率。结果 3组治疗前后肺动脉再通率、Pa O2及肺动脉平均压比较差异均有统计学意义(P<0.01)。治疗后,r-PA静脉泵注组总有效率显著高于r-PA静脉推注组和尿激酶组(P<0.05);r-PA静脉泵注组30 d病死率为0,低于r-PA静脉推注组的25.00%和尿激酶组的22.22%(P<0.05)。3组溶栓后出血率差异无统计学意义(P>0.05)。结论静脉缓慢泵注r-PA治疗急性PE的成功率不低于《肺血栓栓塞症的诊断与治疗指南》规定的传统溶栓治疗方法,且治疗后出血发生率及病死率下降,可能是一种更安全、有效的PE溶栓治疗方法。
Objective To compare the clinical efficacy and safety between different administrations of domestic reteplase via venous pump in thrombolysis of acute pulmonary embolism. Methods 49 patients with acute pulmonary embolism hospitalized in our center during January 2012 and April 2014 were retrospective analyzed and treated with reteplase. Among them,17 patients received reteplase at a dose of 18 mg via venous pump in 2 hours; the other 32 patients were treated with reteplase according to the traditional instruction,namely double intravenous injection with an interval of 30 minutes; in addition,27 patients with acute pulmonary embolism were chosen as control group,who underwent urokinase thrombolysis according to guidelines,and then we observed the recanalization,hemorrhage reaction and 30-day mortality rate respectively. Results The recanalization rates,Pa O2 and the mean pulmonary artery pressure before and after treatment of the three groups showed significant differences（ P〈0. 01）. After treatment,thrombolysis efficient rate of group P was the highest and there was statistically significant difference compared with group T and control group. 30 d mortality rate of r-PA venous pump group was zero,lower than that of the other two groups（ 25. 00% and 22. 22%,P〈0. 05） and there was no significant difference in the hemorrhage reaction rates between the three groups（ P〉0. 05）. Conclusion Patients with acute pulmonary embolism undergoing treatment with domestic reteplase by pumping r-PA slowly can achieve similar effect with the traditional thrombolytic method and the hemorrhage and mortality rates are significantly decreased. It is a more effective and safer method in treating PE.
出处
《临床误诊误治》
2015年第10期89-92,共4页
Clinical Misdiagnosis & Mistherapy
