肺血栓栓塞症急诊溶栓17例分析

Thrombolytic Therapy of Pulmonary Thromboembolism An Analysis of Treatment in 17 Cases

目的:探讨肺血栓栓塞症(PIE)急诊溶栓的临床应用。方法:收集2001年1月至今在我科确诊并行急诊溶栓、资料完整的PIE患者17例,其中男性8例,女性9例,平均年龄(58.1±18.1)岁,回顾性分析其临床特征和治疗,重点分析溶栓治疗的有交性的安全性。结果:①12例(70.1%)确诊或病史提示存在下肢深静脉血栓(DVT);②绝大多数(15例,88.2%)患者出现呼吸困难或胸闷;③溶栓后患者呼吸和心率频率较溶栓前显著下降(P值均<0.001),而PaCO_2及PaO_2较溶栓前升高(P值分别为0.001和0.007);④4例(23.5%)出现出血副作用,其中1例(5.9%)为柏油样便,无溶栓相关性死亡。结论:对于有不明原因呼吸困难或胸闷的患者,应高度怀疑PTE可能,并重点询问是否存在DVT的危险因素。现代溶栓治疗对PTE安全有效,溶栓治疗的实际应用应结合患者的临床表现具体分析。

Objective： To discuss the clinical practice of thrombolysis therapy of pulmonary thromboembolism（PTE）.Methods： Retropeetive analysis of the clinical features and treatments of 12 patients with PTE,and focus on the analysis of efficacy and safety of thrombolysis therapy.Results：①12（70.1%. patients were confirmed or had risk factors of deep vein thrombosis（DVT）;②15（88.2 %） patients presented dyspnea or chest distress;③After receiving thrombolysis therapy, the patients were significantly improved in the respiration and heart rate（P〈0.001）,and both PaCO2 and PaO2 were heightened;④four （23.5%.） patients developed hemorrhages,and only one （5.9%）presented majorhemorrhage（upper gastrointestinal bleeding）.No thrombolysis -related death happened.Conclusions：PTE should be suspected in patients with unexplainable dyspnea and chest distress,and DVT should be precluded at first time.Mordem thrombolysis therapy of PTE is effective and safe.And the individual treatment should be taken to the patients with PTE.