纤溶酶联合抗凝治疗急性次大面积肺血栓栓塞症的有效性及安全性研究

Efficacy and safety of anticoagulation plus fibrinolysin in the treatment of acute submassive pulmonary thromboembolism

目的观察纤溶酶联合抗凝治疗急性次大面积肺血栓栓塞症的有效性和安全性。方法选择经CT肺动脉造影(CTPA)或肺动脉造影和心脏超声心动图明确诊断急性次大面积肺血栓栓塞症的患者,随机分为常规抗凝治疗组、纤溶酶治疗组、尿激酶溶栓组,分别予以单纯抗凝、纤溶酶联合抗凝及尿激酶溶栓抗凝治疗,观察治疗10d后的右心功能及出血副作用的发生率。结果三组治疗前后右心功能比较均差异有统计学意义(P<0.05)。纤溶酶治疗组及尿激酶溶栓组与常规抗凝治疗组右心功能相比差异均有统计学意义(P<0.05),而纤溶酶治疗组与尿激酶溶栓组之间相比差异无统计学意义(P>0.05)。常规抗凝治疗组出血副作用与纤溶酶治疗组比较差异无统计学意义(P>0.05),而常规抗凝和纤溶酶治疗组与尿激酶溶栓组相比差异均有统计学意义(P<0.05),尿激酶溶栓组有更多出血危险性。结论纤溶酶联合抗凝治疗急性次大面积肺血栓栓塞症是一种安全、有效的方法。

Objective To evaluate the efficacy and safety of anticoagulation plus fibrinolysin in the treatment of acute submassive pulmonary thromboembolism.Method From 2003 uo 2007,110 patients of acute submassive pulmonary thromboembolism diagnosed by pulmonary artery angiography,spiral computed tomographic pulmonary angiography（CTPA）or ultrasonic examination were divided into three groups（A,B and C）randomly.34 patients in group A were treated by anticoagulation alone.45 patients in group B were treated with anticoagulation plus fibrinolysin.31 patients in group C were treated with intravenous thrombolysis.Right ventricular function and bleeding incidence were measured respectively before treatment and after 10-day treatment.Results There were significant differences in right ventricular function among three groups before treatment and after 10-day treatment（P〈0.05）.In group B and group C,right ventricular function improved more significantly than group A（P〈0.05）,but there were no significant differences between group B and group C（P〉0.05）.There were no statistical significances in bleeding rate between group A and group B（P〉0.05）.Group C had significantly higher bleeding rate（P〈0.05）.Conclusion Anticoagulation plus fibrinolysin therapy is better selection in acute submassive pulmonary thromboembolism.