中老年人创伤后急性次大面积肺栓塞的溶栓和抗凝治疗

Thrombolysis and anticoagulant therapy for post-traumatic acute submassive pulmonary embolism inmiddle-aged and elderly patients

目的比较溶栓和抗凝治疗在中老年人急性次大面积肺栓塞的有效性和安全性。方法选取我院创伤骨科住院的急性次大面积肺栓塞患者45例，根据患者病情且在其知情同意的情况下分为溶栓组22例和抗凝组23例。在溶栓和（或）抗凝治疗前、后进行症状体征、血气分析、D-二聚体、心脏超声、CT血管造影的监测。结果溶栓组临床总有效率为95．5％（21／22），抗凝组临床总有效率为91．3％（21／23），均无死亡患者，两组间比较差异无统计学意义（X^2=0．32，P〉0．05）。溶栓组出血率27．3％（6例），抗凝组出血率4．3％（1例），两组间差异有统计学意义（X^2=4．53，P〈0．05）。溶栓和（或）抗凝治疗24h后，溶栓组呼吸困难改善率45．5％（10／22）、动脉血氧分压水平（80．4±8．1）mmHg（1mmHg=0．133kPa），较抗凝组17．4％（4／23）、（73．6±9．3）mmHg升高（X^2=2．04，t=2．61，均P〈0．05），肺动脉压水平（51．2±6．2）mmHa较抗凝组（60．3±5．7）mmHg降低，差异有统计学意义（均P〈0．05）。其他各时间点比较，两组差异无统计学意义。结论溶栓可迅速改善症状、降低肺动脉压，建议出血可能性小、病情较重的患者可采用溶栓治疗；而出血可能性大、病情较轻的患者可采用抗凝治疗。

Objective To compare the efficacy and safety of thrombolysis and anticoagulant therapy for post-traumatic acute submassive pulmonary embolism （PE） in middle-aged and elderly patients. Methods Totally 45 patients with post-traumatic acute submassive pulmonary embolism in our hospital were selected. Patients were divided into thrombolysis group （n = 22） and anticoagulation group （n=23） according to their conditions. Symptoms and signs, blood gas analysis, F〉dimer, echocardiography, CT pulmonary angiography （CTPA） were performed before and after thrombolysis or anticoagulant therapy. Results There were no significant differences in clinical curative rate between thrombolysis group and anticoagulation group [95.5 % （21/22） vs. 91.3 % （21/ 23）, X^2=0.32, P〉0.05], and no case was found dead in both two groups. There was a significant difference in hemorrhage rate between thrombolysis group and anticoagulation group [27.3% vs. 4.3%, X^2=4.53, P〈0.05]. At 24 hours after thrombolysis or anticoagulant therapy, the improvement rate of dyspnea, PaO2 level was significantly higher and the pulmonary arterial pressure was significantly lower in thrombolysis group than in anticoagulation group （45.5% （10/22） vs. 17.4% （4/23）, （80.4±8.1） mm Hgvs. （73.6±9.3） mm Hg, （51.2±6.2） mm Hg vs. （60.3± 5.7） mm Hg, respectively, all P〈0.05], and there were no statistical significances at other time points between the two groups. Conclusions The clinical curative rate and fatality rate are similar in thrombolysis group versus anticoagulation group. Hemorrhage rate is higher in thrombolysis group than in anticoagulation group. Thrombolysis can relieve dyspnea rapidly, reduce pulmonary artery pressure and make the embolized blood vessels recanalized. Patients with low bleeding risk in a critical condition are suggested to take thrombolysis therapy, while patients with high bleeding risk in a lightcondition are suggested to take anticoagulant therapy.