阿替普酶溶栓后序贯低分子肝素治疗老年急性次大面积肺栓塞

Sequential Low Molecular Heparin after Alteplase Thrombolytic Therapy in Treatment of Elderly Patients with Acute Massive Pulmonary Embolism

目的探讨阿替普酶溶栓后序贯低分子肝素抗凝治疗老年急性次大面积肺栓塞(acute submas-sive pulmonary embolism,ASPE)的临床效果及安全性。方法选取我科2011年1月—2015年11月治疗的100例老年ASPE,按照随机数字表法分为治疗组和对照组,每组各50例。两组均予对症支持治疗,在此基础上,治疗组予阿替普酶溶栓后序贯低分子肝素抗凝治疗,对照组予尿激酶溶栓后序贯低分子肝素抗凝治疗。观察两组动脉血气及右心室功能变化,记录临床疗效、不良反应发生情况。结果与本组治疗前比较,治疗后两组动脉血气及右心室功能均有所改善,差异有统计学意义(P<0.05);与对照组比较,治疗组治疗后动脉血气及右心室功能明显改善,差异有统计学意义(P<0.05);治疗组总有效率(94.00%)明显高于对照组(80.00%),且轻度及重度出血和死亡率均明显降低,差异有统计学意义(P<0.05)。结论阿替普酶溶栓后序贯低分子肝素抗凝治疗老年ASPE临床效果显著,安全性好。

Objective To investigate clinical effect and safety of sequential low molecular heparin anticoagulation af- ter Aheplase thrombolytic therapy in treatment of elderly patients with acute massive pulmonary embolism （ AMPE）. Methods A total of 100 elderly patients with AMPE admitted during January 2011 and November 2015 were divided into treatment group and control group （n = 50 for each group） according to random digits table method. All patients received supporting therapy. Treatment group was treated with sequential low molecular heparin anticoagulation therapy after Alteplase thrombolytie therapy, while control group was treated with sequential low molecular heparin anticoagulant therapy after Urokinase thrombo- lytie therapy. Changes of arterial blood gas and right ventricular function were observed, and curative effect and incidence rate of adverse reaction were recorded in two groups. Results Compared with those before treatment, arterial blood gas and right ventricular function were improved after treatment in two groups, and the differences were statistically significant （ P 〈 O. 05）. Arterial blood gas and right ventricular function were significantly improved after treatment in treatment group compared with those in control group （ P 〈 0.05）. In treatment group, the total effective rate （94.00%） was significantly higher than that 80.00% in control group, and the mild and severe bleeding and death rates were significantly lower （P 〈 0.05）. Conclusion Sequential low molecular heparin anticoagulation after Ahcplase thrombolytie therapy in treatment of elderly patients with a- cute massive pulmonary embolism is effective and safe.