溶栓加抗凝治疗中危肺血栓栓塞症的临床评价

Clinical evaluation of thrombolytic and anticoagulant therapy in the treatment of pulmonary thromboembolism

目的评价溶栓加抗凝在中危肺血栓栓塞症患者治疗中的价值。方法选取2012年10月至2017年10月我院ICU发生肺血栓栓塞症患者52例为研究对象,随机分为2组:观察组25例,对照组27例。对照组:给予普通肝素配合华法林;观察组:重组组织型纤溶酶原激活剂(rt-PA)50 mg溶栓加普通肝素配合华法林抗凝治疗。观察两组患者不同时间点血氧分压(PO_2)、动脉血二氧化碳分压(PCO_2)、肺动脉压(PAP)及出血相关并发症变化情况。结果观察组PO_2、PCO_2、PAP的改善优于对照组(P<0.05),观察组发生出血情况较对照组略高,均为可控性出血,对生命不造成影响。结论采用溶栓加抗凝治疗中危肺血栓栓塞症患者近期疗效显著,严重并发症无明显增加,可改善患者氧合及降低肺动脉压,改善临床症状。

Objective To evaluate the value of thrombolysis and anticoagulation in the treatment of patients with medium pulmonary thromboembolism.Methods A total of 52 patients with pulmonary thromboembolism in ICU from October 2012 to October 2017 were selected as study subjects.They were randomly divided into 2 groups.Control group（n = 27） was given normal heparin combined with warfarin.Observation group（n = 25） was given recombinanttissuetype plasminogen activator（rt-PA） 50 mg for thrombolysis and common heparin combined with warfarin as anticoagulant therapy.The changes in blood oxygen pressure（PO2）,arterial blood pressure（PCO2）,pulmonary arterial pressure（PAP） and bleeding-related complications were observed at different time points in the two groups.Results The improvement in arterial blood oxygen pressure（PO2）,the partial pressure of carbon dioxide（PCO2） and the pulmonary arterial pressure（PAP） in observation group was more than that of control group（P 〈 0.05）.The bleeding incidence in observation group was slightly higher than that of control group,which was controlled without harm to life.Conclusion The therapy of thrombolysis plus anticoagulation for medium pulmonary thromboembolism patients has significant recent curative effect without increased incidence rate of severe complications,it can improve the clinical symptoms and oxygenation and reduce the pulmonary artery pressure.