136例肺血栓栓塞症溶栓患者临床表现和疗效分析

Thrombolytic Therapy of Pulmonary Embolism:An Analysis of Treatment in 136 Cases

目的:分析136例肺血栓栓塞症(PTE)溶栓患者的临床特点,探讨该溶栓方案的有效性和安全性。方法:分析1990年1月~2006年5月间我院136例接受溶栓的肺栓塞患者的临床表现、实验室检查和影像学资料。Ⅰ组(85例)病程在2周内;Ⅱ组(39例)病程>1个月,症状加重2周内;Ⅲ组(12例)病程和症状加重>2周,但增强计算机断层摄影术判断血栓较新鲜。根据患者情况采用不同剂量如尿激酶(75万U^150万U)或重组组织型纤溶酶原激活剂(50~100mg)溶栓。综合判断溶栓疗效和安全性。结果:76%PTE患者伴有下肢静脉疾患,96%有呼吸困难症状,21%有晕厥史。溶栓后,呼吸频率、心率较溶栓前显著改善(P<0.001)。溶栓总有效率Ⅰ组96%;Ⅱ组77%(与Ⅰ组比较,P=0.001);Ⅲ组100%。溶栓并发症:较大出血3例,其中2例为穿刺点渗血,1例为上消化道出血,无颅内出血及死亡发生。结论:下肢静脉病是PTE主要诱因,对于不能解释的劳力性呼吸困难、晕厥应高度怀疑PTE。PTE的治疗应个体化,溶栓越早越好。该溶栓方案疗效好,出血并发症少。

Objective： To analyze the clinical characteristics and the efficacy and safety of thrombolytic therapy in 136 patients with pulmonary thromboembolism （PTE）. Methods： The history, physical examination, laboratory examination, and imaging examination were evaluated in patients with PTE receiving thrombolytic therapy, and the efficacy and safety of thrombolytic therapy were estimated. Group Ⅰ included 85 patients who presented to hospital ≤ 14 days after the onset of symptoms; group Ⅱ included 39 patients who were presented to hospital 〉 1 month after the onset of symptoms and had worsened symptoms within 14 days; group Ⅲ included 12 patients who presented to hospital 〉 14 days after the onset of symptoms with worsened symptoms 〉 14 days, and the thrombi were fresh judged by imaging. Urokinase （750 000 U-1 500 000 U） ,recombinant tissue-type plasminogen activator （50-100 mg） were administered as thrombolytic agents. Resutls： Seventy-six percent of PTE patients had the complications of lower limb venous diseases （deep vein thrombosis, deep vein phlebitis,or lower limb varicosity ）. Dyspnea was present in 130 of 136 （96%） and syncope was 21%. After receiving thrombolytic therapy ,the patients were significantly improved in respiration rate and heart rate （P 〈 0. 1301 ）. The total effectiveness rate of thrombolytic therapy was 96% in group Ⅰ ,77% in group Ⅱ （compared with group Ⅰ ,P = 0. 001 ） and 100% in group Ⅲ. Three patients developed majorhemorrhages including 2 bleeding of vascular puncture sites with hematocrit decreasing more than 15% and 1 upper gastrointestinal bleeding. No intracranial hemorrhage occurred. Conclusion： Lower limb venous disease is the main cause of PTE. PTE should be suspected in patients with unexplainable exertional dyspnea and syncope. The individual treatment should be taken to the patients with PTE. This project of thrombolytic therapy is effective and safe to the Chinese people.