豁痰祛瘀方联合大剂量rt-PA溶栓治疗急性肺栓塞临床研究

Clinical Study on Huotan Quyu Decoction Combined with Large Doses of rt-PA Thrombolysis in the Treatment of Acute Pulmonary Embolism

目的:观察豁痰祛瘀方联合大剂量重组织型纤溶酶原激活剂(recombinant tissue-type plasminogen activator,rt-PA)溶栓治疗急性肺栓塞的临床疗效,并观察对中医证候积分、血气分析指标、肿瘤坏死因子-α(tumor necrosis factor-alpha,TNF-α)、D-二聚体水平的影响。方法:142例急性肺栓塞患者按抽签方式分为对照组(n=71)与观察组(n=71)。对照组患者给予大剂量rt-PA溶栓治疗,观察组在对照组基础上给予豁痰祛瘀方。比较治疗前后两组血气分析(PaCO_2、PaO_2)、临床证候积分、TNF-α、D-二聚体的水平,并评价两组患者临床疗效。结果:观察组有效率为94.37%(67/71),明显高于对照组的81.69%(58/71),差异具有统计学意义(P<0.05)。治疗后,观察组中医证候积分为(9.36±1.55)分,对照组中医证候积分为(15.64±1.47)分,两组比较,差异有统计学意义(P<0.05)。治疗后,对照组PaCO_2、PaO_2分别为(33.52±1.26)mm Hg(1 mm Hg=0.133 k Pa)、(75.63±1.67)mm Hg,观察组PaCO_2、PaO_2分别为(37.21±1.33)mm Hg、(80.24±1.87)mm Hg,两组比较,差异均有统计学意义(P<0.05)。治疗后,对照组TNF-α、D-二聚体分别为(4.35±1.42)μg·L^(-1)、(486.52±121.42)μg·L^(-1),观察组分别为(2.52±0.87)μg·L^(-1)、(425.63±102.35)μg·L^(-1),两组比较,差异均有统计学意义(P<0.05)。结论:豁痰祛瘀方联合大剂量rt-PA溶栓治疗急性肺栓塞,可显著提高临床疗效,缓解临床症状,提高血气分析指标,降低TNF-α、D-二聚体的水平。

Objective： To investigate the clinical efficacy of Huotan Quyu decoction combined with large doses of recombinant tissue-type plasminogen activator（ rt-PA） thrombolysis in the treatment of acute pulmonary embolism（ APE） and its influence on TCM syndrome integral,blood gas analysis index,tumor necrosis factor-alpha（ TNF-α） and D-Dimer level. Methods： 142 cases of APE patients were divided into control group（ n = 71） and observation group by draw lots. Control group took large doses of rt-PA thrombolysis and observation group took Huotan Quyu decoction on the basis of control group. The arterial blood gas analysis（ PCO2,PO2）,clinical symptom,TNF-α,D-Dimer level of two groups before and after treatment were compared,and clinical efficacy of two groups were evaluated. Results： The effective rate of observation group was 94. 37%（ 67/71）,which was significantly higher than 81. 69%（ 58/71） of control group（ P〈 0. 05）; after treatment,TCM syndrome integral of the observation group was（ 9. 36 ± 1. 55） points,the control group was（ 15. 64 ± 1. 47）,the difference was statistically significant（ P 〈0. 05）. After treatment,PCO2,PO2 of the control group respectively were（ 33. 52 ± 1. 26） mm Hg（ 1 mm Hg = 0. 133 k Pa）,（ 75. 63 ± 1. 67）mm Hg,and the observation group were respectively（ 37. 21 ± 1. 33） mm Hg,（ 80. 24 ± 1. 87） mm Hg,the differences were statistically significant（ P 〈0. 05）. After treatment,TNF-α,D-two dimers of the control group were（ 4. 35 ± 1. 42） μg · L-1,（ 486. 52 ± 121. 42） μg·L-1,and the observation group respectively（ 2. 52 ± 0. 87） μg·L-1,（ 425. 63 ± 102. 35） μg·L-1,and the differences were statistically significant（ P〈 0. 05）. Conclusion： Huotan Quyu decoction combined with large doses of rtPA thrombolysis for treating APE can effectively improve clinical efficacy,relieve clinical symptom and improve blood gas analysis index,reduce the level of TNF-α alpha and D-Dimer two dimer level.