重组人尿激酶原在高危急性肺动脉血栓栓塞症患者导管溶栓治疗中的临床疗效

Effect of recombinant human prourokinase on catheter-directed thrombolysis in high-risk patients with acute pulmonary thromboembolism

目的探讨重组人尿激酶原在高危急性肺动脉血栓栓塞症(APE)患者导管溶栓治疗中的临床疗效。方法收集2017年1月至2020年12月滨州医学院烟台附属医院收治的33例高危APE患者的临床资料,比较患者术前、术后的血气指标[动脉血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、肺泡-动脉血氧分压差(P_(A-a)O_(2))]、右心功能指标[肺动脉压(PAP)、右心室内径]以及出血情况(牙龈出血、皮肤出血点、咯血)。观察患者住院期间的凝血功能指标,包括活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)。随访6个月,测量肺动脉压力,评估患者是否出现慢性血栓栓塞性肺动脉高压。结果33例APE患者均成功完成导管接触性溶栓手术,患者术后呼吸困难、胸闷及憋喘等症状均明显好转或消失。住院期间,APTT为(54.4±2.88)s,PT为(16.0±2.36)s,TT为(29.9±9.66)s。血管造影显示肺动脉栓塞部位均再通,效果满意。术后,33例患者的血气指标及右心功能指标均明显优于治疗前,差异均有统计学意义(P<0.01)。所有患者均未发生出血情况。随访6个月,33例患者均未出现慢性血栓栓塞性肺动脉高压。结论高危APE患者接受导管注入重组人尿激酶原接触溶栓治疗,有效改善了患者的临床症状、血气指标及右心功能,均未发生再次肺动脉血栓栓塞症状,未遗留慢性血栓栓塞性肺动脉高压,值得临床推广应用。

Objective To investigate the clinical effect of recombinant human prourokinase on catheter-directed thrombolysis in high-risk patients with acute pulmonary thromboembolism(APE).Method The clinical data of 33 high-risk APE patients admitted to Yantai Affiliated Hospital of Binzhou Medical University from January 2017 to December 2020 were collected.The preoperative and postoperative blood gas indicators of arterial partial pressure of oxygen(PaO_(2)),carbon dioxide partial pressure(PaCO_(2)),and alveolar-arterial oxygen partial pressure(P_(A-a)O_(2)),right heart function indexes of pulmonary artery pressure(PAP)and right ventricular diameter,bleeding condition of gingival bleeding,skin bleeding spots,and hemoptysis of 33 cases were compared.The indexes of coagulation function during hospitalization were observed,including activated partial thrombin time(APTT),prothrombin time(PT)and thrombin time(TT).During 6-month follow-up,patients'pulmonary artery pressures were measured and they were assessed for the occurrence of chronic thromboembolic pulmonary hypertension.Result All 33 APE patients successfully completed catheter contact thrombolysis,and their symptoms such as dyspnea,chest tightness and wheezing improved or disappeared significantly.During hospitalization,APTT was(54.4±2.88)s,PT was(16.0±2.36)s,and TT was(29.9±9.66)s.Angiography showed that the sites of pulmonary embolism were recanalized with satisfactory results.After the operation,the blood gas indicators and right ventricular function indexes of 33 patients were significantly better than themselves before the treatment,the differences were statistically significant(P<0.01).No bleeding was reported in all patients.During the 6-month follow-up,none of the 33 patients developed chronic thromboembolic pulmonary hypertension.Conclusion High-risk APE patients receiving catheter-infused recombinant human urokinase contact thrombolysis therapy could effectively improve their clinical symptoms,blood gas indicators,and right ventricular function.There is no recurrence of pulmonary thromboembolism symptoms,and no chronic thromboembolic pulmonary hypertension remained.Therefore,the therapy is worthy of clinical application.