瑞替普酶联合华法林在慢性阻塞性肺疾病合并急性中危肺栓塞治疗中的有效性

Efficacy of reteplase combined with warfarin in the treatment of chronic obstructive pulmonary disease complicated with acute middle-risk pulmonary embolism

目的:观察瑞替普酶(rPA)联合华法林在慢性阻塞性肺疾病(以下简称慢阻肺)合并急性中危肺栓塞治疗中的有效性。方法:从近年诊治的慢阻肺合并急性中危肺栓塞的病例中随机挑选76例,分为研究组和对照组,且每组病例数相同。研究组使用rPA联合华法林治疗,对照组使用低分子肝素钠序贯华法林治疗。比较治疗总有效率、血气分析结果、D-二聚体、心肌损伤标志物水平、右/左心室最大短轴直径比(RVd/LVd)及不良反应。结果:研究组与对照组治疗有效率分别为94.7%和78.9%,差异有统计学意义(P<0.05)。研究组PaO2、SaO2升高,PaCO2降低,D-二聚体降低,与对照组差异有统计学意义(P<0.05)。两组患者治疗后心肌损伤标志物水平及RVd/LVd均降低,组间比较差异有统计学意义(P<0.05)。从各组患者采取溶栓抗凝治疗后,持续至疗程结束后60 d,两组均未出现死亡病例,研究组患者中出现1例异常出血以及1例肺栓塞复发;对照组患者中出现6例异常出血以及3例肺栓塞复发。研究组患者异常出血较少,肺栓塞复发率也明显低于对照组(P<0.05)。结论:rPA联合华法林治疗慢阻肺合并急性中危肺栓塞能有效改善症状,抑制心肌损伤,减少不良反应,更加安全有效。

Objective:To investigate the efficacy of reteplase(rPA)combined with warfarin in the treatment of chronic obstructive pulmonary disease(COPD)complicated with acute middle-risk pulmonary embolism.Methods:Totally,76 COPD patients complicated with acute middle-risk pulmonary embolism diagnosed and treated in recent years were randomly selected and divided into the study group and the control group with the same number of cases in each group.The study group was treated with rPA combined with warfarin,and the control group was treated with low molecular weight heparin sodium sequential warfarin.The overall treatment efficacy,blood gas,D-dimer,myocardial injury marker levels,right/left ventricular maximum short axis diameter ratio(RVd/LVd),and adverse reactions were analyzed.Results:The effective rates of treatment in the study group and the control group were 94.7%and 78.9%,respectively,the difference was statistically significant(P<0.05).In the study group,PaO 2 and SaO 2 increased,PaCO 2 decreased,and D-dimer decreased.The differences were statistically significant compared with the control group(P<0.05);after treatment,the levels of myocardial injury markers and RVd/LVd were reduced,and the differences between the groups were statistically significant(P<0.05).Observation was started after thrombolytic anticoagulation treatment in each group,untill 60 days after the end of the treatment period,there were no deaths in both groups.There were 1 abnormal bleeding and 1 recurrence of pulmonary embolism in the study group;6 abnormal bleeding and 3 recurrences of pulmonary embolism in the control group.Patients in the study group had less abnormal bleeding,and the recurrence rate of pulmonary embolism was also significantly lower than that in the control group(P<0.05).Conclusions:The rPA combined with warfarin in the treatment of COPD complicated with acute middle-risk pulmonary embolism can effectively improve symptoms,suppress myocardial injury,reduce adverse reactions,and is more safe and effective.