溶栓加抗凝疗法与单纯抗凝疗法对次大面积肺栓塞的疗效及远期预后的影响

Long Term Prognosis of Thrombolytic Therapy with Urokinase and/or Anticoagulant in Submassive Pulmonary Embolism

目的分析次大面积肺栓塞症患者行溶栓或抗凝治疗的有效性及安全性，并随访1年，观察远期无事件生存率。方法将确诊的106例次大面积肺栓塞症患者随机分为两组，A组（n=51）予以尿激酶20000U／kg静脉滴注。溶栓结束后，开始予以皮下注射低分子量肝素治疗，并重叠口服华法林，尔后单纯应用华法林，直至INR达到2～3。B组（n=55）只用低分子量肝素和华法林抗凝，用法同A组。观察疗效并随访1年，观察主要终点事件（再发肺栓塞、严重出血及死亡）发生率。结果两组一般情况、基础临床情况均无显著差异（P〉0．05）。A组51例用尿激酶溶栓和低分子量肝素抗凝治疗者，46例有效（90．2％），有1例（1．9％）患者发生脑出血；B组55例单用低分子量肝素抗凝治疗者，37例有效（67．3％），无严重出血发生.随访1年时，A组有4例（13．7％）发生主要终点事件，B组有6例（14．5％）发生主要终点事件，两组之间无统计学差异（P〉0．05）。结论联合应用尿激酶溶栓和低分子量肝素抗凝治疗次大面积肺栓塞症患者安全、有效，但与单用低分子量肝素抗凝治疗相比，其并不能改善1年后的无事件生存率。

Objective To analyze the efficiency of thrombolytic therapy and anticoagulative therapy in the patients with submassive pulmonary embolism and their safety, and to observe the rate of event-free survival after one year＇ s follow.up. Methods A total of 106 patients with documented submassive pulmonary embolism were divided into two groups at random. Group A （ n = 51 ） was trea- ted with thrombolysis （urokinase） combined with anticoagulant therapy （low molecular weight heparin and warfarin）, and Group B （ n = 55 ） with simple anticoagulant therapy. All the patients were followed up one year for the observation of the incidences of the events （recurrent pulmonary embolism, severe bleeding, and death）. Results The effective rate was 90.2% （46/51）in Group A and 67.3% （37/55） in GroupB. The occurrence of bleeding in Group A was 1.9% （1/51） , and none bled in Group B. There was no difference in the probability of primary end-point event in the patients with different treatment after one year＇ s follow-up. Major events occurred in 4 cases （ 13.7% ） of Group A and in 6 cases （ 14.5% ） of Group B. Conclusion Thrombolytic therapy with urokinase combined with low molecular weight heparin is.effective and safe for submassive pulmonary embolism, but it does not bring forth the decline of event-free survival rate after one year when compared with simple anticoagulation.