阿替普酶联合利伐沙班治疗急性肺栓塞临床研究

Clinical Study on Alteplase Combined with Rivaroxaban in the Treatment of Acute Pulmonary Embolism

目的探讨阿替普酶联合利伐沙班治疗急性肺栓塞的临床疗效及对患者肺通气功能、凝血功能的影响。方法选取山东省妇幼保健院2015年1月至2017年12月收治的急性肺栓塞患者98例,按随机数字表法分为对照组(口服利伐沙班片治疗)和观察组(口服利伐沙班片联合注射用阿替普酶微量泵入治疗),各49例,均持续治疗4个月。结果观察组总有效率为93.88%,显著高于对照组的75.51%(P<0.05);与治疗前比较,两组患者治疗后的血氧饱和度(SpO2)、静息每分钟通气量(VE)、潮气量(VT)、纤维蛋白原(FIB)水平均显著升高,凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)均显著延长,呼气末二氧化碳分压(PETCO2)及D-二聚体(D-D)水平均显著降低(P<0.05),且观察组上述指标改善程度均显著优于对照组(P<0.05);观察组与对照组的不良反应发生率相当(6.12%比8.16%,P>0.05)。结论注射用阿替普酶联合利伐沙班治疗急性肺栓塞,有利于改善肺通气功能及凝血功能,且不增加不良反应。

Objective To investigate the clinical efficacy of alteplase combined with rivaroxaban in the treatment of acute pulmonary embolism and its effect on pulmonary ventilation function and coagulation function. Methods Totally 98 patients with acute pulmonary embolism admitted to Shandong Maternal and Child Health Hospital from January 2015 to December 2017 were selected and divided into the control group( the patients took Rivaroxaban Tablets orally) and the observation group( the patients took Rivaroxaban Tablets orally and received Alteplase for Injection by micro-pump) according to the random number table method,49 cases in each group. All patients were treated for 4 months. Results The total effective rate of the observation group was 93. 88%,which was significantly higher than 75. 51% of the control group( P < 0. 05). Compared with those before treatment,the levels of pulse oxygen saturation( SPO2),minute ventilation at rest( VE),tidal volume( VT) and fibrinogen( FIB) were significantly increased,the prothrombin time( PT) and activated partial thromboplastin time( APTT) were significantly prolonged,the levels of end-tidal carbon dioxide partial pressure( PETCO2)and D-D were significantly decreased in the two groups after treatment( P < 0. 05),and the improvement of above indexes in the observation group was significantly better than that in the control group( P < 0. 05). The incidence of adverse reactions in the observation group was similar to that in the control group( 6. 12% vs. 8. 16%,P > 0. 05). Conclusion Alteplase for Injection combined with rivaroxaban in the treatment of acute pulmonary embolism can improve the pulmonary ventilation function and coagulation function without increasing adverse reactions.