不同剂量重组组织型纤溶酶原激活剂治疗急性肺栓塞的疗效比较

Comparison of efficacy of different dose recombinant tissue-type plasminogen activator for acute pulmonary embolism

目的:探讨不同剂量重组组织型纤溶酶原激活剂(rt-PA)治疗急性肺栓塞(APE)的疗效。方法:选取2010年1月至2017年5月广西医科大学第九附属医院收治的105例APE患者,按随机数字表法分为观察组(53例)和对照组(52例),观察组采用50 mg rt-PA治疗,对照组采用100 mg rt-PA治疗,比较两组临床疗效。观察患者治疗后右室左右径、主肺动脉径、肺动脉收缩压、动脉血氧分压(PaO_2)、动脉收缩压、D-二聚体水平及预后情况。结果:治疗后60 min及治疗后24 h,两组右室左右径、主肺动脉径、肺动脉收缩压及D-二聚体水平均显著下降,PaO_2、动脉收缩压均显著上升,与治疗前比较差异均有统计学意义(P<0.05);且对照组治疗后60 min的右室左右径、主肺动脉径、肺动脉收缩压及D-二聚体水平明显低于对照组,PaO_2、动脉收缩压明显高于观察组(P<0.05)。两组治疗总有效率、治疗后24 h右室左右径、主肺动脉径、动脉血气指标及D-二聚体水平比较差异无统计学意义(P>0.05)。观察组病死率及出血发生率均低于对照组(P<0.05)。结论:低剂量rt-PA治疗APE的临床疗效与100 mg rt-PA相当,虽然低剂量rt-PA起效较慢,但病死率及出血发生率较低,值得临床推广应用。

Objective： To compare the effect of different dose recombinant tissue-type plasminogen activator （rt-PA） on acute pulmonary embolism （APE）. Methods： 105 APE patients treated in our hospital from January 2010 to May 2017 were selected and randomly divided into an observation group （n=53） and a control group （n=52）. The patients in the observation group received 50 mg rt-PA, while those in the control group received 100 mg rt-PA. The clinical efficacy, right ventricular left and right diameter, main pulmonary diameter, pulmo- nary arterial systolic pressure, PaO2, arterial systolic pressure, D-dimer level and prognosis were compared. Resuits： The right ventricular left and right diameter, main pulmonary diameter, pulmonary arterial systolic pres- sure and D-dimer level were decreased, while PaO2 and arterial systolic pressure were increased in both group at 60 min and 24 h post-treatment （P〈 0. 05 ）, but the improvements at 60 min post-treatment in the control group were more significant compared with the observation group （P〈 0.05）. No significant differences were found between the two group after 24 h treatment with regard to above indexes （P〉0. 05）. The mortality and bleed- ing rate of the observation group were lower than those of the control group （P〈0. 05）. Conclusion： 50 mg rt-PA had a similar efficacy with 100 mg rt-PA for APE, and lower mortality and bleeding rate. High dose rt-PA was more speedy.