两种剂量重组组织型纤溶酶原激活剂对急性肺栓塞患者临床疗效及预后情况的影响比较

Comparison of the effects of different doses of recombinant tissue plasminogen activator on clinical efficacy and prognosis in patients with acute pulmonary embolism

目的探讨两种剂量重组组织型纤溶酶原激活剂对急性肺栓塞患者临床疗效及预后影响性。方法前瞻性选取仙桃市第一人民医院收治的急性肺栓塞患者86例,随机分为对照组和研究组,各43例。对照组予高剂量(0. 9kg/mg)重组组织型纤溶酶原激活剂治疗,研究组予低剂量(0. 6 kg/mg)治疗。观察两组患者治疗前、治疗后凝血功能、临床症状、血管内皮功能、血液学指标变化并比较。结果①两组治疗后脑利钠肽(BNP)、D-二聚体(D-D)、肌酸磷酸激酶(CK)、肌酸磷酸激酶同工酶(CK-MB)、肌钙蛋白T(c Tn T)、肌钙蛋白I(c Tn I)较治疗前均显著降低(P <0. 05),但研究组与对照组比较差异无显著性(P>0. 05)。②两组治疗后纤维蛋白原、纤维蛋白降解产物、α2-抗纤溶酶、纤溶酶原较治疗前均显著下降(P <0. 05),但研究组与对照组比较差异无显著性(P>0. 05),而两组治疗前、治疗后凝血因子XⅢ、血小板比较差异无显著性(P> 0. 05)。③两组治疗后可溶性细胞间黏附因子1(s ICAM-1)、内皮素1(ET-1)、血栓素B2(TXB2)较治疗前均显著下降,6醛前列腺素FIa(6-k-PGFIa)、一氧化氮(NO)较治疗前均显著升高(P<0. 05),但研究组与对照组比较差异无显著性(P> 0. 05)。④两组治疗完成后胸痛、晕厥、咯血、呼吸困难发生率较治疗前均显著降低(P <0. 05),但治疗后两组发生率比较差异无显著性(P> 0. 05)。⑤研究组在颅内出血、粪便潜血(+)、尿潜血(+)、皮肤黏膜出血、脑血管事件发生率上显著低于对照组,差异有统计学意义(P <0. 05)。结论低剂量重组组织型纤溶酶原激活剂治疗急性肺栓塞疗效与高剂量相当,但出血等并发症发生率低。

Objective To investigate the clinical efficacy and prognosis of different doses of recombinant tissue plasminogen activator in patients with acute pulmonary embolism. Methods 86 patients with acute pulmonary embolism were randomly divided into control group and research group,43 cases in each group. The control group was treated with high dose recombinant tissue plasminogen activator and the study group was treated with low dose. The changes of coagulation function,clinical symptoms,vascular endothelial function and hematological indexes before and after treatment were observed and compared between the two groups. Results ①The levels of brain natriuretic peptide( BNP),D-dimer( D-D),creatine phosphokinase( CK),creatine phosphokinase isoenzymes( CK-MB),troponin T( c Tn T) and troponin I( c TnI) in the two groups were significantly lower than those before treatment( P < 0. 05),but there was no significant difference between the study group and the control group( P > 0. 05) . ②After treatment,fibrinogen,fibrinolytic products,alpha 2-antifibrinolytic enzyme and plasminogen decreased significantly in both groups( P < 0. 05),but there was no significant difference between the study group and the control group( P > 0. 05). There was no significant difference in coagulation factor X III and platelet between the two groups before and after treatment. The significance of accounting( P > 0. 05) . ③Soluble intercellular adhesion factor-1( s ICAM-1),endothelin-1( ET-1),thromboxane B2( TXB2) decreased significantly after treatment in both groups,while 6-aldehyde prostaglandin FIa( 6-k-PGFIa) and nitric oxide( NO) increased significantly after treatment( P < 0. 05),but there was no significant difference between the study group and the control group( P > 0. 05) . ④The incidence of chest pain,syncope,hemoptysis and dyspnea in the two groups were significantly lower than those before treatment( P < 0. 05),but there was no significant difference between the two groups after treatment( P > 0. 05) . ⑤The incidence of intracranial hemorrhage,fecal occult blood( +),urinary occult blood( +),skin mucosal hemorrhage and cerebrovascular events in the study group were significantly lower than those in the control group,with significant difference( P < 0. 05). Conclusion Low dose recombinant tissue plasminogen activator has the same efficacy as conventional dose in treating acute pulmonary embolism,but the incidence of complications such as bleeding is low.