中高危组肺栓塞溶栓治疗的有效性和安全性

Efficacy and safety of thrombolytic therapy for intermediate-high risk pulmonary embolism

对于中高危组急性肺栓塞的治疗,长期以来国内外肺栓塞诊疗指南都推荐单纯抗凝治疗,但临床上一直存在争议。争议的焦点主要是溶栓治疗的有效性和安全性。近年来的大多数随机对照临床试验证实,中高危组急性肺栓塞溶栓治疗确实难以降低患者病死率,但是可以更快降低肺动脉压和改善右心室功能,而且能够降低血流动力学代偿失调的发生率。与单纯抗凝治疗相比,虽然溶栓治疗增加危害性很小的轻微出血(minor bleeding)发生率,但并不增加严重出血(major bleeding)发生率,安全性较好。

For the treatment of acute pulmonary embolism in the intermediate-high risk group,domestic and foreign guidelines for diagnosis and treatment of pulmonary embolism have recommended simple anticoagulant treatment for a long time,but there has been controversy in clinical practice.The controversy mainly focuses on the efficacy and safety of the thrombolysis.In recent years,most randomized controlled clinical trials have confirmed that thrombolytic therapy of acute pulmonary embolism in the intermediate-high risk group is indeed difficult to reduce the mortality of the patients,but it can reduce pulmonary artery pressure and improve right ventricular function faster,and reduce the incidence of hemodynamic decompensation.Compared with anticoagulant therapy alone,although thrombolytic therapy increases the incidence of minor bleeding with little harm,it does not increase the incidence of major bleeding.The clinical trials have demonstrated the efficacy and safety of thrombolysis.