阿替普酶与尿激酶治疗急性肺栓塞的疗效比较

Comparative Clinical Analysis of the Efficacy of Alteplase and Urokinase in the Treatment of Acute Pulmonary Embolism

目的比较阿替普酶与尿激酶治疗急性肺栓塞的临床疗效。方法选择2014年1月至2015年12月在首都医科大学电力教学医院就诊的急性肺栓塞患者40例,采用随机数字表法分为对照组和观察组,各20例。对照组采用尿激酶2 U/kg用100 m L 0.9氯化钠注射液稀释后持续静脉滴注2 h;观察组采用阿替普酶50 mg加50 m L注射用水持续静脉滴注2 h。两组患者溶栓治疗后均采用常规肝素和华法林抗凝治疗,疗程为7 d。溶栓治疗后,对两组临床症状改善率,血D-二聚体,双能量CT肺灌注成像灌注缺损指数和栓塞指数,总有效率,出血率和病死率等指标进行比较分析。结果治疗后,观察组呼吸困难、咳嗽和心动过速的改善率分别为95.0%(1/20),85.0%(2/19)和95.0%(1/20),显著高于对照组的70.0%(6/20)、55.0%(8/19)、75.0%(6/20)(P<0.05)。治疗后,观察组血清D-二聚体水平低于对照组[(274±87)mg/L比(325±79)mg/L],差异有统计学意义(P<0.05)。治疗后,观察组肺动脉灌注缺损指数和栓塞指数均低于对照组[(18±6)%比(23±7)%,(16±3)%比(24±5)%](P<0.05)。观察组的总有效率为95.0%(19/20),对照组为85.0%(17/20),两组比较差异无统计学意义(P>0.05)。观察组和对照组的出血率分别为15.0%(3/20)和10.0%(2/20),病死率分别为3.0%(6/20)和3.5%(7/20),两组相比差异无统计学意义(P>0.05)。结论与尿激酶相比,阿替普酶治疗急性肺栓塞可显著降低双能量CT肺灌注成像灌注缺损指数和栓塞指数,疗效确切安全。

Objective To compare the efficacy of alteplase and urokinase in the treatment of acute pulmonary embolism. Methods From Jan. 2014 to Dec. 2015,40 patients with acute pulmonary embolism in Electrical Teaching Hospital of Capital Medical University were included in the study and divided into an observation group and a control group according to the random number table grouping method,20 patients each. The control group received 2 U / kg of urokinase diluted into 100 m L sodium chloride injection by continuous intravenous infusion for 2 h; the observation group was treated with alteplase 50 mg diluted into50 m L water for injection by continuous intravenous infusion for 2 h. After that,both groups were treated with general anti-coagulant of heparin and warfarin for 7 days. The clinical symptom improvement rate,the serum levels of D-dimer,perfusion defect index and embolization index of dual energy CT pulmonary perfusion imaging,the total effective rate,hemorrhage rate and mortality rate of the two groups were analyzed and compared. Results After treatment,the symptom improvement rate of expiratory dyspnea,cough,and tachycardia were 95. 0%（ 1 /20）,85. 0%（ 2 /19） and 95. 0%（ 1 /20） in the observation group,which were significantly higher than the in the control group [70. 0%（ 6 /20）,55. 0%（ 8 /19）,75. 0%（ 6 /20） ]. The level of D-dimer of the observation group was lower than the control group[（ 274 ± 87） mg / L vs（ 325 ± 79） mg / L,P 0. 05]. The pulmonary artery perfusion defectindex and embolism index of the observation group were lower than the control group[（ 18 ± 6） % vs（ 23 ± 7） %,（ 16 ± 3） % vs（ 24 ± 5） %]. The curative effect of the observation group was higher than the control group,which were 95. 0%（ 19 /20）,85. 0%（ 17 /20）,respectively,however,the difference was not statistically significant（ P 〉0. 05）. There was no significant difference in hemorrhage rate and death rate between the two groups after the treatment,which were 15. 0%（ 3 /20） and 10. 0%（ 2 /20）,3. 0%（ 6 /20） and 3. 5%（ 7 /20）,respectively（ P〉 0. 05）. Conclusion In the treatment of acute pulmonary embolism,alteplase can decrease thrombolysis index and pulmonary perfusion defect index in dual energy CT pulmonary perfusion imaging,with affirmative effect and good safety.