摘要
目的比较溶栓和抗凝治疗在中高危肺栓塞患者治疗中的有效性和安全性。方法中高危肺栓塞患者65例分为两组:溶栓组32例,行溶栓联合抗凝疗法;抗凝组33例,仅行抗凝疗法。比较两组治疗前和治疗后24h的症状体征、血气分析、D-二聚体和治疗后14d心脏超声心动图和胸部CT血管造影相关指标。结果治疗24h后,溶栓组呼吸困难改善率、动脉血氧分压和D-二聚体均高于抗凝组(P<0.05),但两组间二氧化碳分压差异无统计学意义(P>0.05)。治疗24h后,溶栓组动脉血氧分压较治疗前改善(P<0.05),D-二聚体上升(P<0.05);治疗14d后,溶栓组肺动脉压较抗凝组降低(P<0.05)。溶栓组出血率高于抗凝组(18.7%vs.3.0%)(P<0.01)。结论对于中高危肺栓塞的患者,溶栓及抗凝均可改善临床症状。溶栓治疗可迅速改善呼吸困难症状,降低肺动脉压,但有一定的出血风险。
Objective To compare the efficacy and safety of thrombolytic and anticoagulant therapy in the treatment of patients with moderate-high risk pulmonary embolism.Methods Sixtyfive patients with moderate-high risk pulmonary embolism were divided into two groups.The patients in group A（32 cases）were treated with thrombolysis combined with anticoagulation therapy and those in group B（33 cases）were treated with anticoagulant therapy only.The changes of symptoms and signs,arterial blood gas analysis and D-dimer before and at 24 hours after treatment were compared between two groups.The indexes of ultrasonic cardiography and thoracic CT angiography were evaluated 14 days after the treatment.Results At 24 hours after treatment,the improvement rates of dyspnea,arterial partial pressure of oxygen（PaO2）and D-dimer in group A were higher than those in group B（P〈0.05）,but there was no significant difference in partial pressure of carbon dioxide between two groups（P〈0.05）.The improvement of PaO2 and increase of D-dimer at 24 hours after treatment were more than those before treatment in group A（P〈0.05）.After treated for 14 days,the pulmonary artery pressure in group A was lower than that in group B（P〈0.05）.The bleeding rate in group A was higher than that in group B（18.7% vs.3.0%）（P〈0.01）.Conclusion Both of thrombolysis and anticoagulation therapy can effectively improve clinical symptoms in the patients with moderate-high risk pulmonary embolism.Thrombolytic therapy can rapidly improve the symptoms of dyspnea,reduce PAP,but has bleeding risk in a certain degree.
出处
《江苏医药》
CAS
2017年第24期1816-1818,共3页
Jiangsu Medical Journal
基金
江苏省自然科学青年基金(BK20151020)
关键词
肺栓塞
抗凝
溶栓
Pulmonary embolism
Anticoagulation
Thrombolysis
