r-tPA与尿激酶对肺栓塞血红蛋白变化及血液流变学变化分析

Changes of hemoglobin and blood rheology in pulmonary embolism with r-tPA and urokinase

目的探讨重组组织纤溶酶原激活物(r-tPA)与尿激酶溶栓治疗肺栓塞患者的临床效果及对患者血红蛋白、血液流变学指标的影响。方法选取我院2014年5月-2015年12月急诊收治的肺栓塞患者62例,根据患者入院顺序分为r-tPA组31例(r-tPA溶栓治疗+低分子肝素抗凝治疗)、尿激酶组31例(尿激酶溶栓治疗+低分子肝素抗凝治疗),对比两组治疗效果。结果两组患者治疗后的SBP、PaO_2测定值较治疗前显著的提高(P<0.05)、PAP、HR测定值较治疗前显著的降低(P<0.05);治疗后,r-tPA组的红细胞比容、纤维蛋白原、全血黏度高切、全血黏度低切测定值低于尿激酶组(P<0.05);治疗前、治疗后,r-tPA组和尿激酶组的Hb水平组间、组内比较差异均无统计学意义(P>0.05);治疗后,r-tPA组的总有效率90.32%与尿激酶组的83.87%比较差异均无统计学意义(P>0.05)。结论 r-tPA与尿激酶溶栓治疗肺栓塞患者均具有较好的临床效果,但r-tPA能够更好的改善患者的血液流变学指标。

Objective To investigate the clinical effect of recombinant tissue plasminogen activator （r-tPA） and urokinase thrombolytic therapy for patients with pulmonary embolism and the influence of the changes of hemoglo- bin and blood rheology. Methods In our hospital from May 2014 to December 2015,62 cases were divided into the r-tPA group （n = 31, r-tPA ＋ low molecular weight heparin and the urokinase group （n = 31, urokinase and low mo- lecular heparin therapy） according to the order of admission. The efficacy of the two groups was compared. Results The value of SBP and PaO2 increased significantly （ P 〈 0.05 ） , and the value of PAP and HR decreased after treatment （P 〈 0.05）. After treatment, hematocrit, fibrinogen, whole blood viscosity at high shear, and low shear blood viscosity were lower in the r-tPA group than in the urokinase group （P 〈 0. 05）. There was no significant difference in Hb between the two groups （P 〉0. 05）. After treatment, the total efficiency was 90. 32% in the r-tPA group and 83.87% in the urokinase group （P 〉 0. 05）. Conclusion R-tPA and urokinase thrombolysis in treatment of pulmo-nary embolism patients have better clinical results, but r-tPA can better improve the patient＇s blood rheology index.