阿替普酶联合低分子肝素钠治疗次大面积肺栓塞患者疗效及相关指标

Efficacy and related parameters of alteplase combined with low molecular heparin sodium ine treatment of sub-large area pulmonary embolism

目的研究和探讨阿替普酶联合低分子肝素钠对于次大面积肺栓塞患者的疗效及对相关指标的影响,指导临床用药。方法收集2013年8月至2017年8月于我科就诊的80例次大面积肺栓塞患者,随机分为观察组与对照组,每组各40例,对照组采用低分子肝素钠皮下注射联合华法林钠口服抗凝,观察组在对照组基础上加用阿替普酶,持续治疗1周后,对比两组患者临床有效率,对比治疗前后肺功能及动脉血氧分压(PaO_2)、二氧化碳分压(PaCO_2),对比两组治疗前后血清B型尿钠肽(BNP)、肌钙蛋白Ⅰ(cTnⅠ)、同型半胱氨酸(Hcy)、D-二聚体(D-D)水平及出血发生率。结果观察组治疗总有效率为97.50%,显著高于对照组的75.00%(P<0.05);治疗前两组患者FEV1%、FEV1/FVC、PaO_2、PaCO_2无统计学差异(P>0.05),治疗后观察组FEV1%、FEV1/FVC、PaO_2显著高于对照组,PaCO_2显著低于对照组(P<0.05);治疗前两组患者血清BNP、cTnⅠ、Hcy、D-D水平无统计学差异(P>0.05),治疗后观察组各项指标显著低于对照组(P<0.05);两组患者出血发生率差异无统计学意义(P>0.05)。结论阿替普酶联合低分子肝素钠治疗次大面积肺栓塞,可以提高治疗有效率,提高肺功能,改善预后,且不会增加出血风险,在临床上应推广运用。

Objective To study and investigate the efficacy of alteplase combined with low molecular weight heparin sodium in the treatment of patients with submaximal pulmonary embolism and its influence on related indicators,and to guide clinical medication. Methods Eighty patients with large pulmonary embolism treated in our department from August 2013 to August 2017 were randomly divided into observation group and control group,with 40 cases in each group. The control group was treated with subcutaneous injection of low molecular weight heparin sodium. In combination with oral anticoagulation with warfarin,the observation group was treated with alteplase on the basis of the control group. After 1 week of continuous treatment,the clinical efficacy was compared between the 2 groups,and pulmonary function and arterial partial pressure of oxygen (PaO2)were compared before and after the treatment. The partial pressure of carbon dioxide(PaCO2)was used to compare the levels of serum B-type natriuretic peptide(BNP),troponin I(cTnI),homocysteine(Hcy),D- dimer(D-D),and bleeding before and after the treatment in both groups. Results The total effective rate was 97.50% in the observation group,which was significantly higher than that in the control group of 75.00%(P < 0.05). There was no significant difference in terms of FEV1%,FEV1/FVC,PaO2 and PaCO2 between the two groups before the treatment(P > 0.05),but FEV1%,FEV1/FVC,PaO2 in the observation group were signifi- cantly higher than those in the control group after the treatment,and PaCO2 was significantly lower (P < 0.05);There was no significant difference regarding to serum BNP,cTnI,Hcy and D-D levels between the two groups before the treatment(P > 0.05),but after the treatment,the indexes of the observation group were significantly lower than those of the control group(P < 0.05). There was no statistical difference in the incidence of bleeding between the two groups(P > 0.05). Conclusion Alteplase combined with low-molecular-weight heparin sodium in the treatment of the next large-area pulmonary embolism can improve the efficiency of treatment,lung function and the prognosis,but will not increase the risk of bleeding. It could be widely used in clinical practice.