阿替普酶联合华法林治疗大面积肺栓塞患者的临床效果评价

Evaluation of the Clinical Effectiveness of Alteplase Combined with Warfarin in the Treatment of Patients with Massive Pulmonary Embolism

目的:探究阿替普酶联合华法林治疗大面积肺栓塞的疗效。方法:选取2016年1月—2021年1月于佛山市南海区人民医院收治的62例大面积肺栓塞患者资料,随机分为观察组与对照组,各31例。观察组予以阿替普酶联合华法林治疗,对照组予以肝素联合华法林治疗。比较两组疗效、凝血功能、血气分析指标、右心功能及不良反应。结果:观察组疗效有效率高于对照组,差异有统计学意义(P=0.003);治疗后,观察组凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、纤维蛋白原水平低于对照组,差异有统计学意义(P<0.05);治疗后,观察组血氧分压、血二氧化碳分压水平高于对照组,心肌肌钙蛋白I水平低于对照组,差异有统计学意义(P<0.05);治疗后,观察组肺动脉压、右室直径、三尖瓣反流差压低于对照组,差异有统计学意义(P<0.001)。结论:阿替普酶联合华法林治疗大面积肺栓塞效果显著,安全性高,且可有效改善心功能损伤、凝血功能、血气分析指标。

Objective:To investigate the efficacy of alteplase combined with warfarin in the treatment of massive pulmonary embo⁃lism.Methods:Sixty-two cases of patients with massive pulmonary embolism admitted to the Foshan Nanhai District People's Hos⁃pital from January 2016 to January 2021 were selected and randomly divided into the observation group and the control group,each with thirty-one cases.The observation group was treated with alteplase combined with warfarin,and the control group was treated with heparin combined with warfarin.The two groups were compared in terms of efficacy,coagulation function,blood gas analysis indexes,right heart function and adverse reactions.Results:The efficacy of the observation group was higher than that of the control group,and the difference was statistically significant(P=0.003);After treatment,prothrombin time,activated partial thromboplastin time,prothrombin time and fibrinogen level of the observation group were lower than that of the control group,and the difference was statistically significant(P<0.05);After treatment,the levels of blood oxygen partial pressure and blood carbon dioxide partial pressure of the observation group were higher than those of the control group,and the level of cardiac troponin I was lower than that of the control group,and the difference was statistically significant(P<0.05);After treatment,pulmonary artery pressure,right ventricular diameter,and tricuspid regurgitation difference of the observation group were lower than that of the con⁃trol group,and the difference was statistically significant(P<0.001).Conclusion:Alteplase combined with warfarin is effective and safe in the treatment of massive pulmonary embolism,and it can effectively improve cardiac function impairment,coagulation func⁃tion,and blood gas analysis indexes.