溶栓与单纯抗凝初始性治疗术前合并中高危肺栓塞癌症患者的疗效比较

Comparison of Clinical Efficacy of Thrombolysis and Pure Anticoagulation Therapy in the Initial Treatment of Cancer Patients with High Risk Pulmonary Embolism before Surgery

目的比较对术前合并中高危肺栓塞的癌症患者,初始治疗采用溶栓与单纯抗凝治疗的疗效和出血风险。方法回顾性分析行手术治疗的26例中高危肺栓塞的癌症患者。比较术前采用单纯抗凝和溶栓治疗,患者右心功能指标、术前准备时间、住院天数、肺栓塞治疗疗效、围术期出血率、术后再发栓塞事件等差异。结果溶栓组患者右室舒张横径等右心功能指标较抗凝组更早改善;此外,肺栓塞治疗疗效、术前准备时间、住院天数、术后血栓事件,溶栓组优于单纯抗凝组,差异均有统计学意义(P<0.05)。而两者围术期出血率比较,差异无统计学意义。结论对于术前合并中高危肺血栓栓塞症的癌症患者,初始治疗采用溶栓对比单纯抗凝,能更早改善右心功能指标,缩短患者的术前准备时间,为患者早日手术创造时机,缩短患者的住院天数,且不增加患者围术期出血风险,可以更好的预防患者术后再发血栓栓塞事件,是安全有效的。

Objective To compare the efficacy and bleeding risk of thrombolysis and pure anticoagulation therapy in the initial treatment of cancer patients with high risk pulmonary embolism before surgery. Methods A retrospective analysis of 26 cases of cancer patients with high risk pulmonary embolism were conducted. Right ventricular function index,preoperative preparation time,length of hospital stay,pulmonary embolism treatment efficacy,perioperative bleeding,postoperative recurrent embolic of patients treated with anticoagulation and thrombolytic therapy were compared. Results Compared with anticoagulation,thrombolytic therapy had earlier improvement in right ventricular diastolic diameter and other right ventricular function indicators; In addition,thrombolytic therapy was better than anticoagulation in the preparation time before surgery,hospital stay,postoperative thrombotic events,the differences were statistically significant. The perioperative bleeding rate between the 2 groups was not statistically significant. Conclusion For preoperative cancer patients combined with high-risk pulmonary thromboembolism,the initial treatment of thrombolytic therapy has earlier improvement in right ventricular function indicators than anticoagulation. Thrombolytic therapy is better than anticoagulation in the preparation time before surgery,hospital stay,postoperative thrombotic events.Thrombolytic therapy is safe and effective for preoperative cancer patients with high risk pulmonary thromboembolism.