尿激酶治疗老年急性次大面积肺栓塞的疗效及安全性探讨

Efficacy and safety of urokinase in treatment of senile acute submassive pulmonary embolism

目的:观察应用尿激酶治疗老年急性次大面积肺栓塞的临床疗效及安全性。方法:回顾性分析我院2010年2月至2013年5月收治的93例老年急性次大面积肺栓塞患者的临床资料,按照治疗方法不同分为治疗组(尿激酶溶栓)48例,对照组(低分子肝素及华法林抗凝)45例,比较两组患者的临床疗效及不良反应情况。结果:治疗组总有效率为91.7%,对照组总有效率为77.8%,治疗组总有效率明显高于对照组(χ2=8.225,P=0.037),两组基本生命体征及动脉血气分析结果较治疗前均显著改善,且治疗组的氧分压改善幅度显著大于对照组(P<0.05),治疗组右房内径、右室内径、主肺动脉内径、肺动脉收缩压均较治疗前、同期对照组有明显改善(P<0.05),两组患者出血率比较无明显差异(P>0.05),但治疗组28 d病死率明显低于对照组(P<0.05),具有统计学意义。结论:应用尿激酶治疗老年急性次大面积肺栓塞可有效改善右心功能、提高血栓再通率,有助于改善患者预后。

Objective：To observe the clinical efficacy and safety in treatment of elderly patients with acute submassive pulmo-nary embolism. Methods：93 elderly patients with acute submassive pulmonary embolism from Feb. 2010 to May 2013 in our hospital were chosen and divided into treatment group （ Urokinase,48 cases） and control group（ low molecular weight heparin and warfarin,45 cases）,the clinical efficacy and adverse reactions were compared. Results：The total efficacy of treatment group was 91. 7%,higher than 77. 8% in control group （χ2=8. 225,P=0. 037） . Compared with the control group,basic vital signs and arterial blood gas analysis re-sults of two groups had significant differences,the PO2 value of the observation group had more magnitude improvement than the control group （P〈0. 05）. Compared with before treatment and concurrent control group,the right atrial,right ventricular diameter,main pulmo-nary artery,pulmonary artery systolic pressure of treatment group had significant improvement （ P〈0. 05 ） , the bleeding rates of two groups had no significant difference（P〉0. 05）,but the 28 days mortality of treatment group was lower than control group（P〉0. 05）. Conclusion：Urokinase in treatment of the acute submassive pulmonary embolism can improve the right ventricular function effectively, increase thrombus recanalization rate and improve the prognosis.