中高危急性肺血栓栓塞症患者溶栓联合抗凝与单纯抗凝治疗的近期疗效比较

Short-term effect of thrombolysis-plus-anticoagulation therapy versus anticoagulation alone in patients with mediate-to-high risk of acute pulmonary thromboembolism

目的:回顾性评价单纯抗凝治疗与溶栓联合抗凝治疗,对中高危急性肺血栓栓塞症(肺栓塞)患者的近期疗效。方法:以治愈、显效、进步、无效、恶化和死亡6级判断标准进行疗效评价,以治愈+显效+进步为有效,计算有效率,以恶化+死亡计算严重事件发生率,对比分析溶栓联合抗凝治疗与单纯抗凝治疗中,高危急性肺栓塞患者住院期间的疗效和出血发生率。结果:北京潞河医院呼吸与危重症医学科,2013年1月至2015年12月共收治175例肺栓塞患者,其中68例为中高危肺栓塞患者,溶栓联合抗凝治疗组(溶栓组)32例,男性14例,女性18例,年龄(61.7±10.6)岁,单纯抗凝治疗组(抗凝组)36例,男性14例,女性22例,年龄(65.1±11.8)岁。治疗后,溶栓组有效率为90.6%(29/32),明显高于抗凝组的63.8%(P=0.013)。两组均无死亡病例,两组间的严重事件发生率相似(0 vs.2.7%,P=0.252)。1例抗凝组患者出现脑出血,未出现中度出血并发症,轻微出血并发症在两组间差异无统计学意义(P>0.05),两组患者住院时间差异无统计学意义(P>0.05)。抗凝治疗时给予华法林6mg的负荷量患者较无负荷量的患者住院时间明显缩短(P<0.05)。结论:对于中高危急性肺栓塞患者,选择溶栓治疗近期可更好地改善右心功能障碍而不增加出血风险。华法林初始抗凝时给予负荷量可缩短住院时间。

Objective： To evaluate the short-term efficacy and safety of thrombolysis plus anticoagulation versus anticoagulation alone in patients with mediate-to-high risk of pulmonary thromboembolism （PTE）. Methods： The efficacy was evaluated based on 6 grades： cure, marked improvement, improvement, un- changed, deterioration and death. Taking cure, marked improvement and improvement as effectiveness, deterioration and death as severe bleeding event. Compare the efficacy and bleeding risks of thrombolysis combined anticoagulation （thrombolysis group） versus anticoagulation alone （anticoagulation group） in patients with low- to-high risk of PTE. Results： In a retrospective established database, 175 patients with PTE were screened from January 2013 to December 2015. Of those, 68 patients with mediate-to-high risk of PTE were enrolled. Based on different therapy protocols, 68 patients were divided into thrombolysis group and anticoagulation alone group. 32 patients in the thrombolysis group with the age of （61.7 ± 10. 6） years old, 36 patients in the antico- agulation group with the age of （65.1 ± 11.8） years old. Before discharge, the effectiveness in thrombolysis group was significantly higher than anticoagulation group （90. 6% vs. 63.8%, P = 0. 013）, severe bleeding e-vents was similar in two groups （0 vs. 2. 7%, P =0. 252）. No case died in both groups. 1 patient in the anti- coagulation group occured cerebral bleeding. However, the risk of mild bleeding was similar between the two groups （ P 〉 0. 05 ）, the time of hospitalization stay also had no significant difference between the two groups （ P 〉 0. 05）. The patient prescribed with 6mg Warfarin as the primary treatment had shorter the time of hospitalization stay than the patients with 3mg （P 〉 0. 05 ）. Conclusion： For mediate-to-high risk of PTE patients, thrombolysis combined with anticoagulation treatment could improve the right ventricular function and without increase the risk of bleeding.