瑞替普酶治疗老年患者急性肺血栓栓塞症的疗效评价

Clinical efficacy of reteplase on the aged patients with acute pulmonary thromboembolism

目的探讨瑞替普酶溶栓治疗急性肺血栓栓塞症(APTE)老年患者的临床疗效及其安全性,为APTE老年患者寻找最佳治疗方案。方法选择我院56例急性肺血栓栓塞症老年患者,依据治疗方案不同分为:对照组,30例,应用低分子肝素治疗;研究组,26例,应用瑞替普酶联合低分子肝素治疗。比较两组患者临床疗效、血管再通率及治疗72h出血并发症的差异;比较两组患者平均肺动脉压(MPAP)、肺功能及凝血功能指标的差异。随访6月,比较两组出血性事件、复发及猝死率的差异。结果与对照组比较,研究组的总有效率及血管再通率显著较高(P<0.05),而治疗72 h出血并发症无显著差异(P>0.05);研究组的MPAP显著较低(P<0.05),而动脉氧分压(Pa O_2)、氧饱和度(Sa O_2)FEV1及FEV_1/FVC显著较高(P<0.05);研究组的D-二聚体(D-Dimer)、纤溶酶原激活物抑制物-1(PAI-1)、组织型纤溶酶原激活物(t-PA)显著较低(P<0.05)。随访6个月,两组出血性事件发生率无差异(P>0.05),而研究组的复发率及猝死率明显低于对照组(P<0.05)。结论急性肺血栓栓塞症老年患者应用瑞替普酶和低分子肝素疗效及安全性较好。

Objective To analyze the clinical efficacy and safety of thrombolytic therapy by reteplase combined with low molecular weight heparin（ LMWH） on the aged patients with acute pulmonary thromboembolism（ APTE）,in order to find the best treatment for aged patients with APTE. Methods 56 aged patients diagnosed as APTE were collected and divided into two groups. The control group（ 30 cases） received LMWH,and the research group（ 26 cases） received reteplase and LMWH. According to the variation of thrombolytic therapy,the clinical efficacy index,revascularization rate and the occurrence of hemorrhage complication 72 h post-therapy were compared between the two groups. The indexes of mean pulmonary artery pressure（ MPAP）,pulmonary function and coagulation function were compared between the two groups. After 6 months follow-up,the occurrences of hemorrhagic events,recurrence and sudden death were compared between the two groups. Results Compared to the control group,the total effective rate and re-vascularization rate in the research group were higher（ P〈0. 05）,but the occurrence of hemorrhage complication 72 h post-therapy were no different between the two groups（ P〈0. 05）. The index of MPAP was lower（ P〈0. 05）,but the indexes of Pa O_2,Sa O_2,FEV1 and FEV_1/FVC were higher（ P〈0. 05）,and the indexes of D-Dimer,PAI-1 and t-PA were lower in the research group than in the control group（ P〈0. 05）. After 6 months follow-up,the occurrences of hemorrhagic events were no different between the two groups（ P〈0. 05）,and the occurrences of recurrence and sudden death in the research group were lower than in the control group（ P〈0. 05）. Conclusion The clinical efficacy and safety of thrombolytic therapy by reteplase combined with LMWH on the aged patients with APTE is perfect.