基于文献的中国肺栓塞患者药物治疗与国内指南符合程度的比较研究

A comparative study on the degree of compliance between drug treatment and domestic guidelines of pulmonary embolism based on literature in China

目的:了解中国肺栓塞患者药物治疗状况,为规范治疗提供依据。方法:检索CNKI,WANFANG DATA,VIP数据库,检索时限从建库至2018年8月,根据纳排标准筛选文献。统计肺栓塞患者的基本信息、溶栓适应证、溶栓时机、溶栓/抗凝药物选择及用法、特殊情况合并肺血栓栓塞症(pulmonary thromboembolism,PTE)的药物治疗等,并与国内肺栓塞诊治指南做比较分析。结果:纳入108篇文献的1 068例肺栓塞患者,其中1 045例使用溶栓和/或抗凝治疗。42.63%溶栓治疗的患者使用rtPA 50 mg、尿激酶2万U·kg-1 2 h持续静脉滴注;20.88%急性高危PTE患者明确使用普通肝素(unfraction heparin,UFH)初始抗凝治疗;12.17%的患者胃肠外抗凝24 h内重叠华法林治疗等指标,与"指南"推荐意见偏离较大。99.14%的患者初始抗凝选择低分子肝素(low molecular weight heparin,LMWH)、UFH、磺达肝癸钠、负荷剂量的利伐沙班或阿哌沙班;93.50%的高危PTE患者进行溶栓治疗;83.52%急性非高危PTE患者使用单纯抗凝治疗等指标,与"指南"推荐意见符合率较高。结论:国内肺栓塞药物治疗状况与"指南"推荐有一定差距,有必要进行改善。

Objective: To investigate the drug treatment status of patients with pulmonary embolism in China, and provide evidence for standard treatment. Methods: Database including CNKI, WANFANG DATA and VIP were searched from inception to August 2018, and the literatures were selected according to the standard of the row. Collected the information of patients with pulmonary embolism, thrombolytic indications, time of thrombolysis, selection of thrombolytic/anticoagulant drugs and usage, and medical treatment of special conditions with PTE, etc., and compared with domestic diagnosis and treatment guidelines for pulmonary embolism. Results: A total of 108 references were included, involving 1 068 patients with pulmonary embolism. 1 045 patients with pulmonary embolism were treated with thrombolytic and/or anticoagulant drugs. 42.63% of patients with thrombolytic drugs were treated with rtPA 50 mg and urokinase 2 WU·kg-1 2 h for continuous intravenous thrombolysis;20.88% of patients with acute high-risk PTE anticoagulant therapy were explicitly treated with UFH in initial anticoagulant therapy. 12.17% of patients had parenteral anticoagulation overlapped warfarin within 24 hours and so on, the indicators of which deviate significantly from the ‘guidelines’. 99.14% of patients who used anticoagulant therapy used initial anticoagulation with LMWH, UFH, fondaparinux, a loading dose of rivaroxaban or apixaban;93.50% of patients with high-risk PTE were treated with thrombolytic therapy;83.52% of patients with acute non-high-risk PTE only used anticoagulant therapy and so on, the indicators of which are more consistent with the ‘guideines’. Conclusions: There are gaps between drug treatment of pulmonary embolism in China. It is necessary to improve the clinical drug treatment status of pulmonary embolism according to the ‘guidelines’.