急性中高危肺血栓栓塞治疗决策的选择、疗效及预后分析

Selection of therapeutic schedule and therapetic effects as well as prognosis analysis in treatment of acute middle-high risk pulmonary thromboembolism

目的探讨急性中高危肺血栓栓塞症治疗决策的选择并分析疗效及预后。方法 43例急性中高危肺血栓栓塞症患者为研究对象,其中溶栓组12例,接受重组组织型纤溶酶原激活剂(rt-PA)溶栓治疗后桥接低分子肝素钠治疗;抗凝组31例,为接受低分子肝素钠单纯抗凝治疗。分析2组患者的病例特点、治疗效果及预后情况。结果与抗凝组相比,溶栓组患者的年龄更小,BMI值更高,合并COPD的比例更高,呼吸困难和咳嗽的症状更为突出,血氧分压更低,需要无创呼吸机或经鼻高流量给氧的比例更高,栓塞部位更集中于主干,差异均有统计学意义(P<0.05)。2组患者治疗后的主要实验室指标均好于治疗前。溶栓组出血率高于抗凝组(P<0.05),但抗凝组随访发现PTE复发2例,慢性血栓栓塞性肺动脉高压1例。结论在临床实践中合并COPD的主干栓塞并严重缺氧的非低体重非高龄中高危PTE患者更适合选择溶栓治疗;溶栓与抗凝均可取得较好疗效,溶栓虽出血风险增加,但远期预后可能好于抗凝治疗。

Objective To investigate the therapeutic schedule, and to analyze the therapeutic effects and patient's prognosis in treatment of acute middle-high risk pulmonary thromboembolism. Methods The clinical data about 43 patients with acute middle-high risk pulmonary thromboembolism who were treated in our hospital from January 2013 to December 2017 were retrospectively analyzed,in whom, 12 patients were treated by thrombolysis with rt-PA and low molecular heparin sodium (thrombolysis group),however,the other 31 patients were treated by low molecular heparin sodium anticoagulant therapy (anticoagulation group).The the therapeutic effects and patient's prognosis were observed and compared between the two groups. Results As compared with those in anticoagulation group,the patient's age was younger,BMI and proportion of patients with COPD were higher,and the symptomes of dyspnea and cough were more severe,and proportion of patients who neede non-invasive ventilator/nasal high flow was higher in thrombolysis group.The main laboratory indexes after treatment in both groups were better than those before treatment.Moreover bleeding rate in thrombolysis group ( 41.7%) was significantly higher than that (12.9%) in anticoagulation group ( P <0.05).In addition 2 cases had PTE recrudesce and 1 case had CTEPH in anticoagulation group. Conclusion Thrombolytic therapy is more suitable to be used in patients with acute middle-high risk PTE complicated by CPOD,combining with severe hypoxia,non-low weight,non-old age.Both thrombolysis and anticoagulation can achieve better curative effects.Although the risk of bleeding increases by thrombolysis treatment,the long-term prognosis of patients may be better than that by anticoagulation therapy.