阿替普酶治疗急性肺栓塞高危患者29例疗效观察

Therapeutic effect of alteplase on high-risk acute pulmonary embolism in 29 patients

目的探讨阿替普酶溶栓治疗急性肺栓塞高危患者的效果及安全性。方法 29例急性肺栓塞患者均应用阿替普酶进行溶栓治疗,溶栓后24h行CT肺动脉造影评定疗效,行超声心动图检查观察溶栓前、后右心室舒张末期前后径(anterior-posterior diameter,APD)、右心室舒张末期横径(transverse diameter,TD)、肺动脉压(pulmonary arterial pressure,PAP)、三尖瓣反流压差(tricuspid valve pressure gradient,TRPG)、右心室壁运动幅度(right ventricular wall motion amplitude,RVAWM),检测溶栓前、后D-二聚体、B型脑钠肽((brain natriuretic peptide,BNP)水平,记录溶栓后不良反应发生情况。结果本组有效率为93.1%;溶栓后APD、TD、PAP、TRPG较溶栓前下降,RVAWM较溶栓前增加(P<0.05);D-二聚体、BNP水平较治疗前下降(P<0.05);溶栓后出血4例,死亡1例。结论阿替普酶适用于急性肺栓塞高危患者的快速溶栓治疗。

Objective To investigate the therapeutic effect and safety of alteplase on high-risk acute pulmonary embolism. Methods Twenty-nine patients with acute pulmonary embolism were treated with atenolol enzyme, and underwent computed tomographic pulmonary angiography （CTPA） 24 hours after thrombolysis to evaluate the therapeutic effect and underwent echocardiography to observe right ventricular end diastolic anterior-posterior diameter （APD） and transverse diameter （TD）, pulmonary arterial pressure （PAP）, tricuspid valve pressure gradient （TRPG）, right ventricular wall motion amplitude （RVAWM） before and after thrombolysis. The levels of D-dimer and brain natriuretic peptide （BNP） were detected and compared before and after treatment, and the adverse reactions were recorded after thrombolysis. Results The total effective rate was 93. 1% . APD, TD PAP and TRPG decreased, and RVAWM increased after thrombolysis （P 〈 0.05）. The level of D-dimer and BNP decreased significantly （P 〈0.05） after thrombolysis. Four cases developed bleeding and one died. Conclusions Alteplase can be used in the thrombolysis for high-risk acute pulmonary embolism patients.