尿激酶与瑞替普酶分别联合华法林和低分子肝素治疗高危组急性肺栓塞的临床疗效及对凝血系统的影响

The efficacy and impact on the coagulation system of urokinase and reteplase combined with warfarin and low molecular weight heparin in patients with acute pulmonary embolism

目的探讨尿激酶与瑞替普酶分别联合华法林和低分子肝素治疗高危组急性肺栓塞的临床疗效及对凝血系统的影响。方法选取某院2013年3月—2015年3月收治的高危组急性肺栓塞患者93例,按照随机数字表法患者分为A组30例、B组32例、C组31例。A组给予华法林联合低分子肝素治疗,B组给予尿激酶联合华法林和低分子肝素治疗,C组给予瑞替普酶联合华法林和低分子肝素治疗。比较3组患者的临床疗效、溶栓后血管再通率,检测患者治疗前后血浆D-二聚体(D-D)、蛋白S(PS)、蛋白C(PC)、凝血调节蛋白(TM)、抗凝血酶Ⅲ(AT-Ⅲ)、纤溶酶原激活物抑制物-1(PAI-1)、组织型纤溶酶原激活物(t-PA)水平。结果 B组和C组溶栓后血管再通率高于A组,C组溶栓后血管再通率高于B组,差异有统计学意义(P<0.05)。B组和C组总有效率高于A组,差异有统计学意义(P<0.05);C组总有效率高于B组,差异有统计学意义(P<0.05)。治疗前3组患者肺动脉收缩压、动脉收缩压和动脉氧分压比较,差异无统计学意义(P>0.05);治疗后B组和C组动脉收缩压和动脉氧分压高于A组,肺动脉收缩压低于A组,差异有统计学意义(P<0.05);治疗后C组动脉收缩压和动脉氧分压高于B组,肺动脉收缩压低于B组,差异有统计学意义(P<0.05)。治疗前3组患者各凝血-纤溶指标比较,差异无统计学意义(P>0.05);治疗后B组和C组血浆PS、PC、D-D、PAT-1和TM水平低于A组,差异有统计学意义(P<0.05);治疗后C组血浆PS、PC、D-D、PAT-1和TM水平低于B组,差异有统计学意义(P<0.05)。结论瑞替普酶联合抗凝的治疗方案对高危组急性肺栓塞患者的疗效、纤溶-凝血系统改善效果和血管内皮细胞改善效果均优于尿激酶联合抗凝的治疗方案。

Objective To explore the efficacy and impact of the coagulation system of urokinase and reteplase com-bined with warfarin and low molecular weight heparin in patients with high risk group of acute pulmonary embolism. Methods A total of 93 high - risk group of patients with acute pulmonary embolism in a hospital from March 2013 to March 2015 were se-lected,they were divided to group A of 30 cases,group B of 32 cases,group C of 31 cases according to the random number. Group A received low molecular weight heparin combined with warfarin therapy,group B received urokinase combined with low molecular weight heparin and warfarin therapy,group C received reteplase combined with warfarin and low molecular weight hep-arin. The clinical efficacy,post thrombolytic recanalization rate,plasma D - dimer( DD),protein S( PS),protein C (PC),thrombomodulin(TM),antithrombin Ⅲ( AT - Ⅲ),plasminogen activator inhibitor - 1( PAI - 1),tissue - type plasminogen activator(t - PA)levels before and of the three groups were compared. Results The post thrombolytic recanaliza-tion rate of group B and group C were higher than group A(P < 0. 05);the post thrombolytic recanalization rate of group C was higher than group B(P < 0. 05);the total efficiency of group B and group C were higher than group A(P < 0. 05);the total efficiency of group C was higher than group B(P < 0. 05);systolic blood pressure and arterial oxygen partial pressure of group B and group C were higher than group A after treatment(P < 0. 05),the pulmonary artery systolic pressure was lower than the group A(P < 0. 05);after the treatment,systolic blood pressure and arterial oxygen partial pressure of group C were higher than group B,pulmonary artery systolic pressure was lower than group B( P < 0. 05);after the treatment,PS,PC,DD, <br> PAT - 1 and TM of group B and group C were decreased compared with group A,PS,PC,DD,PAT - 1 and TM of group C were decreased compared with group B(P < 0. 05). Conclusion Fibrinolytic therapy combined with anticoagulation treatment on acute pulmonary embolism have a more significant treatment effect. The efficacy,fibrinolysis coagulation system improving effect and vascular endothelial cells improving effect of reteplase combined anticoagulant therapy in patients with high risk group of acute pulmonary embolism were better than urokinase combined anticoagulant therapy.