祛痰救肺汤辅助rt-PA溶栓对急性肺栓塞的治疗效果及对凝血指标、TNF-α及D-D水平的影响

Effect of Qutan Jiufei Decoction Assisted by rt-PA Thrombolytic Therapy on Acute Pulmonary Embolism and Its Effect on Levels of Coagulation Index, TNF-α and D-D

目的观察祛痰救肺汤辅助重组织型纤溶酶原激活剂(recombinant tissue-type plasminogen activator, rt-PA)溶栓对急性肺栓塞的治疗效果及对凝血指标、TNF-α及D-D水平的影响。方法选择2018年2月—2019年10月医院收治的急性肺栓塞患者97例,依据治疗方式的不同分为研究组和对照组,研究组49例,对照组48例。对照组入院后均给予氧气吸入、镇痛、检测心率、血压等常规治疗,并采用大剂量rt-PA溶栓,具体:将100 mg阿普替酶加入50 mL注射用水中,采用静脉输注,并2 h内输注完。研究组在对照组治疗的基础上,口服祛痰救肺汤治疗。两组均治疗2周。比较两组治疗前后中医症候积分和临床疗效;比较两组治疗前后PaO2、PaCO2和HR水平;比较两组治疗前后凝血功能指标PT、APTT和TT;比较两组治疗前后TNF-α和D-D水平。结果研究组治疗总有效率为87.76%(43/49)高于对照组总有效率的70.83%(34/48)(P<0.05);研究组治疗后气短、胸痛、心悸、咳嗽和疲惫乏力等中医证候积分低于对照组(P<0.05);研究组治疗后PaO2、PaCO2水平高于对照组,HR水平低于对照组(P<0.05);研究组治疗后凝血功能指标PT、APTT和TT水平高于对照组(P<0.05);研究组治疗后TNF-α和D-D水平低于对照组(P<0.05)。结论祛痰救肺汤结合rt-PA溶栓治疗急性肺栓塞疗效显著,可有效的改善患者的临床症状,纠正患者的低氧血症和血气功能,改善急性肺栓塞患者纤溶-凝血系统,减轻炎症损伤,提高治疗疗效,值得临床推广应用。

Objective To observe the therapeutic effect of Qutan Jiufei Decoction assisted by rt-PA thrombolysis on acute pulmonary embolism and the effect on levels of coagulation index, TNF-α and D-D. Methods Ninety-seven patients with acute pulmonary embolism admitted to our hospital from February 2018 to October 2019 were selected and divided into study group and control group according to different treatment methods, 49 in study group and 48 in control group. The patients in the control group were given routine treatment such as oxygen inhalation, analgesia, heart rate and blood pressure detection after admission, and thrombolysis with high dose of recombined tissue type plasminogen activator(rt-PA). Specifically, 100 mg aprotinase was added into 50 mL water for intravenous injection. The infusion was completed within 2 hours. The study group was treated with Qutan Jiufei Decoction on the basis of the control group. Both groups were treated for 2 weeks. Before and after treatment, TCM symptom score and clinical effect were compared between the two groups. Levels of PaO2, PaCO2 and HR before and after treatment were compared between the two groups. Coagulation function indexes Pt, APTT and TT before and after treatment were compared between the two groups. Levels of TNF-α and D-D before and after treatment were compared between the two groups. Results The total effective rate in the study group was 87.76%(43/49), which was higher than that in the control group(P<0.05). After treatment, the scores of TCM symptoms such as shortness of breath, chest pain, palpitations, cough and fatigue were lower in the study group than those in the control group(P<0.05). After treatment, the levels of PaO2 and PaCO2 in the study group were higher than those in the control group, and the level of HR was lower than that in the control group(P<0.05). The levels of PT, APTT and TT were higher in the study group than those in the control group(P<0.05). The levels of TNF-α and D-D in the study group were lower than those in the control group(P<0.05). Conclusion Qutan Jiufei Decoction combined with rt-PA thrombolytic therapy has a significant effect in the treatment of acute pulmonary embolism. It can effectively improve the clinical symptoms of patients, correct the hypoxemia and blood gas function of patients, improve the fibrinolytic-coagulation system of patients with acute pulmonary embolism, reduce inflammatory injury, and improve the treatment effect, which is worthy of clinical promotion and application.