尿激酶溶栓治疗对急性肺栓塞患者呼吸功能的影响

Effect of urokinase on respiratory function in patients with acute pulmonary embolism

目的研究尿激酶溶栓治疗对急性肺栓塞患者呼吸功能的作用，评估其获益和风险。方法回顾性分析2008—10—01．2015—12—01南京医科大学第一附属医院收治的急性肺栓塞患者，选取其中存在呼吸衰竭而循环稳定病例共52例。根据是否接受尿激酶溶栓分为溶栓组和未溶栓组，分别为33例和19例。比较两组患者在不同病程阶段的氧合指数、呼吸过速率、氧疗依赖率以及30d内的严重出血率和非严重出血率。结果病程第15天，与非溶栓组比较，溶栓组患者的氧合指数明显升高（P〈0．05），呼吸过速率、氧疗依赖率明显降低（P〈0．05）；病程第30天，溶栓组患者氧合指数仍明显高于未溶栓组（P〈0．05），不过两组患者呼吸过速率、氧疗依赖率比较差异无统计学意义（P〉0．05）；溶栓组患者非严重出血率[14（42．4％）]明显高于非溶栓组[3（15．8％）]（P〈0．05），而严重出血率[3（9．1％）VS．1（5．3％）]在两组间比较差异无统计学意义（P〉0．05）。结论尿激酶溶栓治疗可提高肺栓塞患者的呼吸功能，且可能并不增加危及生命的出血风险。

Objective To study the effect of urokinase on respiratory function in patients with acute pulmonary embolism, and to evaluate its benefit and risk. Methods In a retrospective study, a total of 52 acute pulmonary embolism patients with respiratory failure and stable hemodynamics were admit- ted to the First Affiliated Hospital of Nanjing Medical University between October 1, 2008 and October 1, 2015. According to whether been treated urokinase, patients were divided into thrombolysis group and non-thrombolysis group with 33 cases and 19 cases respectively. The ecphysesis rate, the oxygen depen- dence rate and the oxygenation index in different time points, and the incidence of hemorrhage in 30 days were compared between two groups. Results In the fifteenth day course, compared with the non-throm- bolysis group, the ecphysesis rate, theoxygen dependence rate and the oxygen dependence of the thrombolysis group were significantly improved （P 〈 0.05）. In the 30-day course, the oxygenation index in the thrombolysis group [ 14 （42.4%） ] was still significantly higher than that in the non-thrombolysis group [ 3 （15.8%） ] （P 〈 0.05）, however there was no significant difference between the two groups [3 （9.1%） vs.1 （5.3%）] in the ecphysesis rate and the oxygen dependence rate （P 〉 0.05）. The non-severe bleeding rate in the thrombolysis group was significantly higher than that in the non-thrombolysis group （P〈 0.05）, and there was no significant difference in the severe bleeding rate between the two groups （P 〉 0.05）. Conclusion Urokinase may improve the respiratory functions of patients with acute pulmonary embolism, and may not increase the risk of life-threatening bleeding.