小剂量阿替普酶对老年急性次大面积肺栓塞的疗效

Effects of lowdose alteplase on acute submassive pulmonary embolism in senile patients

目的 研究小剂量阿替普酶对老年急性次大面积肺栓塞的疗效和安全性。方法 选择2013年2月-2015年12月在我院诊治的老年急性次大面积肺栓塞患者80例,随机分为两组,各40例。对照组给予华法林和低分子肝素治疗;观察组在此基础上,静脉泵入小剂量（50 mg）阿替普酶,两组均治疗2 w后,比较两组治疗前和治疗后的疗效及动脉血气和右心功能的变化。结果 观察组的治疗总有效明显高于对照组（P〈0.05）;与治疗前相比,治疗后两组的氧分压、二氧化碳分压、肺泡动脉氧分压差、D-二聚体、肌钙蛋白和脑钠肽均得到了明显改善（P〈0.05）,且观察组的改善程度更明显（P〈0.05）;治疗后两组的肺动脉压、右室直径和三尖瓣反流压差均得到了明显改善（P〈0.05）,且观察组的改善程度更明显（P〈0.05）。结论 小剂量阿替普酶对老年急性次大面积肺栓塞有较好的疗效,能明显改善动脉血气和右心功能,且不良反应少,安全有效。

Objective To study the effects and safety of lowdose alteplase on acute submassive pulmonary embolism in senile patients. Methods A total of 80 senile patients with acute submassive pulmonary embolism admitted to our hospital from February 2013 to December 2015 were selected and randomly divided into two groups （n = 40, respectively）. The control group was treated with warfarin and low molecular heparin; the observation group was additionally treated with lowdose （50 mg） alteplase by intravenous pump; the two groups were treated for two weeks. The efficacy and changes in arterial blood gases and right heart function before and after the treatment were compared, Results The overall response rate （ORR） in the observation group was higher than that in the control group （P 〈 0.05）; the arterial blood gases, partial pressure of carbon dioxide, alveolar-arterial oxygen tension difference, D-dimer, troponin and brain natriuretic peptide （BNP） after the treatment were significantly improved （P 〈 0.05）, and those in the observation group improved more obviously （P 〈 0.05）; the pulmonary arterial pressure, right ventricular diameter and tricuspid regurgitation differential pressure were significantly improved （P 〈 0.05）, and the improvement in the observation group was more obvious （P 〈 0.05）. Conclusion Lowdose alteplase is effective for acute submassive pulmonary embolism in senile patients, can improve arterial blood gases and right ventricular function, and is safe and effective, causing few adverse reactions.