急性肺血栓栓塞症溶栓疗效评价

Evaluation of thrombolysis in acute pulmonary thromboembolism

目的应用多层螺旋CT肺动脉造影评价急性肺血栓栓塞症(PTE)尿激酶溶栓治疗前后血栓的变化。方法总结分析18例急性PTE患者临床表现,溶栓前后实验室检查及心脏超声的变化,应用多层螺旋CT计数溶栓前后血栓累及肺段数量。结果本组患者以胸闷、气短为主诉就诊,院前误诊率(88.9%,16/18),3例(16.7%)曾出现晕厥,经溶栓治疗后临床症状明显缓解;心脏超声显示溶栓后右房、右室直径明显缩小(P<0.05);多层螺旋CT肺动脉造影显示血栓累及肺段数量溶栓后明显减少(P<0.001);其中6例患者血栓完全消失,溶栓治疗前与治疗后的血栓累及肺段数量有相关性(r=0.742,P<0.001)。结论尿激酶溶栓方案对于PTE安全有效,多层螺旋CT肺动脉造影能够明确显示溶栓治疗前后血栓的变化,可作为评价治疗效果的重要客观检查。

Objective To evaluate the efficacy of urokinase thrombolysis in acute pulmonary thromboembolism by multi-slice computed tomography pulmonary angiography （CTPA）. Methods The clinical features of eighteen patients with acute pulmonary thromboembolism, the lab results, echoeardiography and the number of pulmonary lobar arteries with thrombosis were analyzed before and after thrombolysis. Results Short breath was the main symptom, and syncope was up to 16.7% （3/18）. All symptoms were relieved by thrombolysis. In these patients, misdiagnosis rate was 88.9 % （16/18）. The diameters of right atrium and ventricle,and the number of pulmonary lobar arteries with thrombosis were obviously reduced after thrombolysis （P 〈 0.05 and P 〈 0. 001, respectively）. In addition, the thrombosis disappeared after thrombolysis in six patients. There were correlation between the number of pulmonary lobar arteries with thrombosis before thrombolysis and the number of them after thrombolysis （ r =0. 742, P 〈0.01）. Conclusion The treatment of urokinase thrombolysis is safe and efficient for acute pulmonary thromboembolism. CTPA can be used to definitely evaluate the change of thrombosis in pulmonary arteries before and after thrombolysis.