降纤酶与尿激酶治疗急性脑梗死患者的临床观察

1　资料与方法4 0例急性脑梗死患者均符合 1986年全国第二次脑血管病学术会议通过的各类脑血管病诊断标准 ,且经CT或磁共振成像等检查无溶栓禁忌证。根据 1995年全国脑血管病会议通过的脑卒中患者临床神经功能缺损程度评分标准评分大于 8分。随机分为两组 ,降纤酶治疗组 (降纤酶组 ) 2 0例 ,其中男性 14例 ,女性 6例 ,年龄 5 0～ 77(5 6± 11)岁。尿激酶对照组 (尿激酶组 ) 2 0例 ,男性 16例 ,女性 4例 ,年龄 5 1～ 76(5 7± 10 )岁。两组梗死部位及合并疾病基本相同。入院治疗时间窗降纤酶组 (5 .7± 1.2 )h ,尿激酶组 (5 .8± 0 .8)h ;两…     

急性心肌梗死急诊介入治疗对炎性细胞因子影响的研究

目的观察急性心肌梗死(AMI)患者的梗死相关血管开通前后致炎细胞因子白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)和抗炎细胞因子白细胞介素-10(IL-10)的动态变化。方法采用酶联免疫吸附法测定8例健康人(健康对照组)和22例AMI患者急诊经皮冠状动脉介入治疗(急诊PCI组)术前即刻、术后12、24 h,血浆IL-1βI、L-6、IL-10的变化,比较致炎细胞因子IL-1βI、L-6和抗炎细胞因子IL-10的变化幅度。结果再灌注前急诊PCI组患者血浆IL-10略高于健康对照组,但无统计学差异(P>0.05),IL-1βI、L-6却显著高于健康对照组[(27.98±8.76)ng/Lvs(20.44±11.32)ng/L,P<0.05;(31.89±6.89)ng/Lvs(15.55±3.81)ng/L,P<0.05];再灌注后122、4 h急诊PCI组患者血浆IL-1βI、L-6及IL-10均较术前显著增高(P<0.01,P<0.01,P<0.05)。急诊PCI组患者再灌注治疗后12 h抗炎细胞因子IL-10的升高幅度显著低于致炎细胞因子IL-1βI、L-6的升幅(P<0.01)。结论心肌缺血再灌注后致炎细胞因子较抗炎细胞因子增高更显著。     

急性心肌梗死患者血浆神经肽Y水平变化的研究

神经肽Y(NPY)是一种体内分布广泛的血管活性多肽。本研究拟观察急性心肌梗死患者发病、发展、转归过程中血浆NPY水平的变化,同时探讨溶栓治疗、心功能改变等因素对心梗患者血浆NPY水平的影响。1　对象和方法1.1　对象　选择符合WHO诊断标准的急性心肌梗死(AMI)患者30例,其中男28例,女2例,年龄36～76岁(平均60.2±10.3岁)。选择健康对照者32例,男21例,女11例,年龄34～80岁(平均62.5±11.3岁)。1.2　方法　健康对照者于晨空腹时,取肘静脉血5ml,急性心肌梗死患者溶栓者,取溶栓前、溶栓后2h、发病后8,12,24,48,72h,5,7,14,21d,非溶栓者取…     

前列地尔脂肪乳剂对急性心肌梗死微循环再灌注的影响

目的探讨前列地尔脂肪乳剂(Lipo-PGE1)对急性心肌梗死(AMI)溶栓后微循环再灌注的影响.方法首次发病6 h之内的AMI溶栓治疗判为临床再通者56例分为对照组,24例;Lipo-PGE1组,32例.后者溶栓前予Lipo-PGE110 μg静脉注射,余治疗同对照组.统计2 h内心电图ST段抬高指数(∑STI)下降≥50%率与ST段完全回落率.测量溶栓前及溶栓后24 h的QRS积分.测定溶栓前即刻及溶栓后2 h、10 h血小板聚集率.结果Lipo-PGE1组与对照组比较①心电图∑STI下降≥50%率、ST段完全回落率均显著提高(96.9%∶75.0%,P<0.05;84.4%∶58.3%,P<0.05);②溶栓后2 h两组血小板聚集率Lipo-PGE1组明显低于对照组[(31±18)%∶(45±22)%,P<0.01],10 h两组相同[(15±7)%∶(13±6)%,P>0.05];③溶栓治疗后24 h Lipo-PGE1组QRS积分明显低于对照组(5.2±0.3∶5.9±0.4,P<0.05).结论Lipo-PGE1能通过迅速抑制血小板功能,减轻心肌微循环的无复流现象,减少心肌梗死面积.     

婴幼儿室间隔缺损合并重度肺动脉高压术后心排量与氧代谢的变化规律

目的:总结分析婴幼儿期室间隔缺损合并重度肺动脉高压心脏直视术后心排量与氧供、氧耗的变化规律及临床意义。方法:室间隔缺损合并重度肺动脉高压患儿25例,男性15例,女性10例。年龄0.5～2.75(1.25±0.68)岁,体质量5～13.7(8.68±2.49)kg,术前经皮血氧饱和度(SPO2)0.95～0.99(0.97±0.70),超声心动图检查平均肺动脉压力65～82(67.86±21.35)mmHg(1 mmHg=0.133 kPa)。合并心脏畸形包括:房间隔缺损9例,动脉导管未闭5例,主动脉弓缩窄3例。麻醉时经颈内静脉置入4F Swan-Ganz漂浮导管,经桡动脉置入动脉测压管。分别于手术结束即刻、术后4 h、8 h、12h、24 h、48 h及72 h,由桡动脉及漂浮导管抽取动脉和混合静脉血标本行血气分析。热稀释法测定心排量(CO),PHLIPS M:8007 A计算心排指数(CL)、氧供指数(DO2I)、氧耗指数(VO2I)、氧摄取率(O2ER)。结果:①术后DO2I与VO2I显著相关,术后即刻呈线性依赖;②术后8 h CI、DO2I、VO2I最低;O2ER最高。结论:婴幼儿期室间隔缺损合并重度肺动脉高压,术后即刻存在着病理性氧供依赖,术后8 h既存在氧供不足又有氧耗下降,应积极提高心排量改善组织氧分。     

应用国产尿激酶冠状动脉腔内溶栓治疗急性心肌梗塞24例临床分析

急性心肌梗塞(AMI)24例,年龄51～70岁(平均59.06±5.72岁),全部男性.其中急性下壁心肌梗塞5例,下壁及右室梗塞5例,前间壁梗塞4例,前壁梗塞9例及心内膜下心肌梗塞1例.患者入院距胸痛发病1～6h(平均3.4±1.2h),PTCR开始距胸痛发病1.5～8.0h(平均4.5±1.5h).UK用量;96万u10例,再通9例,120万u9例,再通8例,144万u5例,再通1例,总共18例再通,平均再通率75%.PTCR开始至再通时间,最短30分钟,最长90分钟,平均45±15分钟.其再通距发病时间2.0～9.5h,平均5.5±1.7h.再通时间<3h者近期预后好;>6h者近期并发症多.全组24例无脑卒中及重要脏器出血,仅穿刺部位血肿4例,18例再通者无急性冠再闭塞现象,但有不同程度再灌注损伤,未通组6例中2例有频发室早.本组有7例并发糖尿病,占AMI发病率29.2%,5例以“心性哮喘、急性左心衰”、2例以“心源性休克”入院.1例糖尿病再通患者于溶栓后第4天死于泵功能衰竭.     

急性心肌梗死院前溶栓的可行性

急性心肌梗死 ( AMI)静脉溶栓治疗的最佳时机是在症状出现后 1～ 2 h之内 ,然而这一宝贵时机却由于各种原因而错过。为提高早期溶栓率 ,使更多的 AMI患者得到及时溶栓治疗 ,本文结合我院溶栓实际探讨基层院前溶栓的可行性。1　对象与方法1 .1 　 对象符合溶栓标准 ( 1 996年 )者 62例 ,其中院前溶栓 8例 ,急诊室溶栓 1 7例 ,CCU溶栓 37例。男 45例 ,女 1 7例 ,年龄 36～ 76(平均 59)岁 ;梗死部位 :广泛前壁 7例 ,前壁 41例 ,下壁 9例 ,下壁加右室 3例 ,前间壁加侧壁 2例。发病到开始溶栓时间 1 .5～9h,其中院前组 ( 4 .0± 2 .5) h,急诊…     

糖尿病急性心肌梗死早期病死率性别差异的探讨

目的 探讨性别对糖尿病急性心肌梗死(AMI)早期病死率的影响及其原因。资料与方法 分析181例AMI:男95例,年龄(67.86±11.18)岁,其中糖尿病50例;女86例,年龄(75.08±6.78)岁,其中糖尿病46例。对男女患者住院30d病死率、年龄、血糖、血脂、从症状出现至就诊时间、溶栓及介入治疗进行比较。结果 女性AMI病死率高于男性(27.91％vs 12.63％),糖尿病AMI病死率高于非糖尿病(25.00％vs 14.12％),糖尿病AMI女性病死率高于男性(36.96％vs 14.00％),女性糖尿病AMI年龄较大,空腹血糖、甘油三酯高于男性,出现症状至入院时间较长,溶栓治疗与介入治疗较少,以上因素进行多因素回归分析发现性别、出现症状至入院时间与糖尿病急性心肌梗死早期病死率有关。结论 女性急性心肌梗死病死率高于男性,尤其是糖尿病急性心肌梗死。     

体外膜肺氧合对心脏术后心肺复苏患者的应用

目的:探讨体外膜肺氧合技术(ECMO)在成年心脏手术后心肺复苏(CPR)困难患者的应用经验。方法:回顾分析2010年1月至2012年9月期间,7例心脏手术后因CPR困难应用ECMO救治的成年患者的临床资料,男性4例,女性3例,年龄42～65岁,平均(54±7)岁,其中冠状动脉旁路移植术(CABG)6例,主动脉瓣置换术1例。全部患者均经股动静脉插管建立ECMO辅助。结果:7例患者CPR时间40～65 min,平均(53±7)min,建立ECMO辅助后全部患者均恢复自主心律,ECMO辅助时间36～128 h,平均(85±26)h,监护室停留时间2～8d,平均(5±1)d。辅助24h后患者平均动脉压(MBP)、血乳酸(Lac)及正性肌力药物评分(IS)均明显改善。6例(85.7%)患者成功撤离ECMO辅助,其中3例(42.9%)存活出院,1例患者因无法脱机而死亡,3例成功脱机后因感染及中枢神经系统并发症死亡;4例患者同时应用主动脉内球囊反搏(IABP),3例进行肾替代治疗(CRRT)。结论:体外膜肺心肺复苏(ECPR)可以提供紧急生命支持,挽救部分常规方法复苏困难的心脏术后心脏骤停患者的生命。     

重组组织型纤溶酶原激活剂动静脉联合溶栓治疗急性缺血性卒中

目的探讨使用重组组织型纤溶酶原激活剂(rt-PA)动静脉联合溶栓治疗急性缺血性卒中的临床疗效及安全性。方法回顾性分析106例发病在6 h内的急性缺血性卒中患者的临床表现、治疗方法及疗效。其中超选择性动脉溶栓+静脉溶栓组(联合组)60例,同时超选择性动脉溶栓组(动脉组)46例。动脉组用微导管超选择至病变动脉,输注rt-PA50 mg;联合组先静脉输注rt-PA,再经病变动脉输注rt-PA,总量<50 mg,在溶栓前和溶栓后6 h、24 h、7 d及30 d时,采用欧洲卒中量表(ESS)评价神经功能缺损情况。结果治疗前ESS评分,联合组为42±13,动脉组为43±10,治疗后24 h、30 d时,ESS评分联合组为82±23、89±25;动脉组为76±27、82±23。治疗后总再通率联合组为53%(32/60),动脉组为35%(16/46),两组比较差异有统计学意义(P<0.05)。颅内出血的发生率联合组为7%(4/60),动脉组为9%(4/46),两组比较差异无统计学意义。结论脑梗死患者起病6 h内,动静脉联合溶栓是相对安全、有效的治疗方法。     

益气温阳、活血利水法预防急性肺血栓栓塞的实验研究

目的探讨益气温阳、活血利水法在预防急性肺血栓栓塞（APTE）的作用及其可行性。方法48只健康新西兰大耳白兔,随机分为4组,每组12只,即空白对照组、栓塞对照组、益气温阳活血利水中药防治组（中药组）、华法林组。每只兔均经耳缘静脉取血,制成自体血栓栓子备用。4组均给予常规饲料喂养,中药组加益气温阳活血利水作用的中药灌胃,含生药0.8g/kg,华法林组加华法林溶液灌胃,0.06mg/kg,每日1次。空白对照组、栓塞对照组同时给等量生理盐水灌胃。1周后,分别经右股静脉注入自体血栓栓子,于栓塞后1h,4h采血测定动脉血气分析、一氧化氮（NO）、内皮素-1（ET-1）、血栓素B2（TXB2）,并于4h后处死兔,进行肺病理学观察。结果益气温阳、活血利水中药组栓塞后病理损伤明显轻于其他组,注入栓子1h,4h后,中药组NO、血氧分压（PaO2）水平均高于栓塞对照组（P〈0.05）,ET-1,TXB2均低于栓塞对照组（P〈0.05）,血二氧化碳分压（PaCO2）与栓塞对照组无统计学意义;中药组NO,PaO2高于华法林组,ET-1低于华法林组,PaCO2和TXB2与华法林组无统计学意义。结论预防性应用益气温阳活血利水法可减轻APTE后肺缺血损伤,改善缺氧状态,调节血管内皮功能,抑制血小板分泌血栓素A2（TXA2）。此法在预防APTE方面具有可行性,有效性。     

Association between antithrombotic treatments and prognosis of patients with acute pulmonary thromboembolism in Japan.

The utility of thrombolysis in patients with acute pulmonary thromboembolism (APTE) remains controversial, although anticoagulation therapy for APTE is well-established in Western countries. Nonetheless, large clinical trials of antithrombotic treatments for APTE have yet to be performed in Japan. In the present study, the association between antithrombotic treatments (thrombolysis and anticoagulation) and the clinical outcomes was retrospectively investigated in 225 APTE patients. In-hospital mortality was significantly lower in hemodynamically stable patients who received anticoagulation therapy than in those who received no adequate therapy (0% vs 33%). Thrombolysis in patients with or without cardiogenic shock failed to improve the in-hospital outcomes compared with those who received anticoagulation treatment (8% vs 3%). There was no significant difference in the bleeding rate between patients receiving thrombolysis and anticoagulation (3% vs 3%). These results indicate that anticoagulation could reduce the mortality of hemodynamically stable APTE patients and that the outcome after thrombolysis or anticoagulation treatment was similar. However, this study was limited because it was executed retrospectively. Further prospective randomized trials to investigate the efficacy of thrombolysis in Japan should be performed to completely address this issue.     

IL-13、TGF-β在急性肺血栓栓塞兔模型中的表达

目的 通过研究IL-13、转化生长因子β(TGF-β)在急性肺血栓栓塞兔模型中的表达,探讨Th2型免疫反应在急性肺栓塞发病机制中的作用.方法 选取大耳白兔36只,分为模型组及对照组,每组18只.采用自体血栓回输法建立肺血栓栓塞模型.分别于栓塞后第2、4、14天采集模型组及对照组血清,应用酶联免疫吸附试验方法检测IL-13、TGF-β含量.结果 模型成功率为90%.模型组血清中IL-13、TGF-β水平分别于栓塞后第4、14天升高,分别为(36.86±3.06)ng/L、(1591.67±55.02)ng/L,显著高于对照组(P值均<0.05).结论 肺栓塞进程中IL-13与TGF-β水平升高.     

急性肺栓塞大鼠血清血管紧张素转换酶1的变化

目的探讨急性肺栓塞大鼠血清血管紧张素转换酶1的变化。方法雄性SD大鼠24只,随机分为对照组,栓塞后24 h组,栓塞后1周组,每组8只;以明胶海绵溶液经颈静脉注入制备大鼠肺栓塞模型,对照组注入同等体积生理盐水。3组大鼠分别于1周(对照组)、栓塞后24 h、栓塞后1周时处死。经右心导管测定肺动脉压、心率、呼吸频率,取动脉血行动脉血气分析及血清血管紧张素转换酶1活性测定;取肺组织制备病理切片,HE染色光镜下观察肺动脉栓塞情况。结果对照组,栓塞24 h组,栓塞1周组大鼠肺动脉平均压分别为(14.2±4.1)mm Hg(1 mm Hg=0.133 kPa)(、26.1±7.5)mm Hg(、26.1±6.8)mm Hg(P<0.05);动脉血氧分压分别为(94.1±8.8)mm Hg(、80.5±5.8)mm Hg(、80.4±13.8)mm Hg(P<0.05);3组大鼠血清血管紧张素转换酶1分别为(30.5±7.2)U/L(、53.5±15.9)U/L(、45.8±17.4)U/L(P<0.05)。光镜下观察,栓塞后24 h组肺组织切片均可见多个肺动脉管腔内海绵明胶栓塞,有继发红血栓形成,肺组织充血、水肿、炎性细胞浸润;栓塞后1周组大鼠部分肺动脉管腔内海绵明胶溶解。结论急性肺栓塞大鼠肺动脉压升高的同时,血清血管紧张素转换酶1明显升高,其程度可能与肺血管床阻塞的范围或程度有关。     

犬急性肺血栓栓塞部分血管活性物质的实验研究

目的　探讨内皮素(ET)、一氧化氮(NO)、肾上腺髓质素(ADM)和C型利钠肽(CNP)在肺血栓栓塞时的变化及对血流动力学的影响。方法　14只健康杂种犬随机分为肺栓塞组和对照组。栓塞组注射自体血栓,对照组注射温生理盐水。每只犬在注栓前、注栓后的半小时、1、2、4及6h各时点记录血流动力学指标和进行动脉血气分析,收集动脉血标本,检测ET、CNP、ADM和NO的变化。结果　组织病理符合肺血栓栓塞的改变;栓塞组在栓塞后动脉血气血氧分压较栓塞前及对照组明显降低(P <0 .0 5 ) ;栓塞组在栓塞后平均肺动脉压(MPAP)和肺血管阻力(PVR)较栓塞前及对照组明显升高(P<0 .0 5 ) ;与对照组比较,ET和NO在栓塞后2、4及6h明显升高(P <0 .0 5 )。ADM在栓塞后1、2h明显升高(P <0 .0 5 ) ;CNP在栓塞后2h明显升高(P <0 .0 5 )。结论　血管活性物质ET、NO、ADM和CNP参与急性肺血栓栓塞的病理生理过程。     

Clinical characteristics of acute pulmonary thromboembolism in Japan: results of a multicenter registry in the Japanese Society of Pulmonary Embolism Research

BACKGROUND: Although the incidence of acute pulmonary thromboembolism (APTE) has been increasing in Japan, patient characteristics, management strategies, and outcome have not yet been assessed in large series. HYPOTHESIS: The present study was designed to investigate the current status of APTE in Japan. METHODS: Of a total of 533 registry patients with pulmonary thromboembolism, 309 with APTE were analyzed with respect to clinical symptoms and signs, predisposing factors, diagnostic procedures, estimation of deep venous thrombosis, treatment, and clinical course. RESULTS: Main risk factors were recent major surgery, cancer, prolonged immobilization, and obesity; only a few patients had coagulopathy and 36% were in cardiogenic shock at presentation. The majority of registry patients underwent lung scans or pulmonary angiography; 30% were diagnosed only by lung scanning. Venous ultrasonography was used in only 34 patients, while 188 patients underwent at least one diagnostic procedure for deep venous thrombosis. Thrombolysis was more frequently performed in patients with cardiogenic shock, and only a few patients received thromboembolectomy. In-hospital mortality rate was 14%. In patients with cardiogenic shock, the mortality rate was reduced by thrombolysis. The predictors of in-hospital mortality were male gender, cardiogenic shock, cancer, and prolonged immobilization. CONCLUSIONS: The patients in this registry had almost the same findings as those in Western patients, except for some points that had the possibility of demonstrating a difference between Westerners and Japanese in the development of APTE. These results can prove especially helpful in planning prospective, randomized trials that will clarify the impact of widely used treatment modalities on the outcome of patients with APTE.     

Beneficial effect of octreotide treatment in acute pancreatitis in rats

Summary Conclusions Octreotide treatment contributes to the regulation of tumor necrosis factor (TNF) production in sodium taurocholate-induced acute necrotizing pancreatitis in rats. Owing to its complex effect, octreotide can partially ameliorate the deleterious consequences of acute necrotizing pancreatitis. Elevated TNF and interleukin-6 (IL-6) levels in the peritoneal fluid may be considered a consequence of the activation of peritoneal macrophages. Background The effects of octreotide on exocrine pancreatic function have been investigated in numerous studies, but little attention has been paid to its influence on cytokine production in acute pancreatitis. Methods Acute pancreatitis was induced by the retrograde injection of taurocholic acid into the pancreatic duct in male Wistar rats. Serum amylase activity, wet pancreatic weight/body weight (pw/bw) ratio, and TNF and IL-6 levels were measured. Four μg/kg of octreotide was administered subcutaneously at the time of induction of pancreatitis and 24 or 48 h later. Rats were sacrificed 6, 24, 48, or 72 h after the operation. Results The serum amylase level and pancreatic weight to body weight ratio were decreased significantly in the octreotide-treated group. The serum TNF level was decreased significantly in the octreotide-treated group as compared with the control group at 6, 24, and 48 h (0.6±1.5, 2.0±3.3, and 0 vs. 50±15.5, 37.5 ±18.4, and 13.1±12.5 U/mL, respectively). The ascites TNF level was decreased to 0 in the octreotide-treated group and was elevated in the control group at 72 h (28.0±49.0 U/mL). IL-6 production in ascites was extremely high in both groups at 6 h (80,000±43, 817 pg/mL and 58, 500±33 335 pg/mL), but the difference was not significant.     

Study of the echocardiographic diagnosis of acute pulmonary thromboembolism and risk factors for venous thromboembolism

OBJECTIVES: To identify the relationship of risk factors for atherosclerosis with venous thromboembolism (VTE) and the utility of transthoracic echocardiography in acute pulmonary thromboembolism (APTE). METHODS: In 75 patients with VTE (VTE group), 101 patients with suspected VTE (N group), and 50 control subjects (control group), the frequency of atherosclerosis risk factors such as hyperlipidemia, obesity, hypertension, smoking, and diabetes mellitus and the number of risk factors were evaluated. Transthoracic echocardiographic findings such as tricuspid regurgitation, right ventricular dilation, pulmonary hypertension, and right ventricular dysfunction were evaluated in 15 patients with APTE (APTE group) and 38 patients in the N group (NC group). RESULTS: The incidence of hyperlipidemia in the VTE group was statistically higher than that in the control group (odds ratio 2.16, 95% confidence interval 1.43-3.08). Additionally, the incidence of obesity was higher in the VTE and N groups than in the control group (odds ratio was 2.76, 95% confidence interval 1.67-4.37). Risk factors other than obesity and hyperlipidemia and the number of risk factors were not significant. The incidence of tricuspid regurgitation, right ventricular dilation, and pulmonary hypertension in APTE was statistically greater than that in NC group. Right ventricular dilation and right ventricular dilation + tricuspid regurgitation are reliable findings in echocardiography. However, even combining with tricuspid regurgitation, right ventricular dilation is insufficient to identify or screen patients with APTE. CONCLUSIONS: Hyperlipidemia and obesity may be risk factors for VTE. However, obese patients can manifest similar findings to VTE. Although transthoracic echocardiograpghy is not recommended as a diagnostic or screening test in APTE, it should be used as an ancillary test.     

急性肺血栓栓塞应用瑞替普酶溶栓治疗的价值及对TNF-α、IL-8的影响

目的探讨瑞替普酶溶栓治疗急性肺血栓栓塞的价值及对TNF-ɑ、IL-8的影响。方法选择2013年8月至2015年8月住院收治的84例急性肺血栓栓塞患者为研究对象,按随机数字表法分为观察组42例和对照组42例。两组患者入院后均给予常规处理,首先建立静脉输液通道,并给予普通肝素治疗。观察组给予瑞替普酶18mg溶于10m L生理盐水中,静脉注射2min以上;30min以后再次用药18mg;对照组给予尿激酶150万U溶于100m L生理盐水中,静脉滴注30min。两组患者溶栓完毕后,应用达肝素钠注射液抗凝,并重叠应用华法林钠抗凝治疗;两组患者疗程均为6个月。比较两组患者的临床效果、TNF-ɑ、IL-8、Hcy、Pa O_2、Pa CO_2、肺动脉压、收缩压的变化水平,并记录两组患者的不良反应发生情况。结果溶栓治疗后,观察组总有效率90.5%显著高于对照组71.4%(P0.05);两组患者TNF-ɑ、IL-8、Hcy、肺动脉压较治疗前明显降低,Pa O_2、Pa CO_2、收缩压较治疗前显著提高(P0.05),其中观察组改善程度优于对照组(P0.05);两组患者穿刺部位出血、镜下出血、牙龈出血、鼻出血等不良症状,经对症处理后恢复正常,两组间不良反应比较无明显差异(P0.05)。结论瑞替普酶溶栓治疗急性肺血栓栓塞患者疗效确切,有效降低炎性因子TNF-ɑ、IL-8水平,改善患者血气水平,安全可靠,值得临床推广应用     

Risk factors of acute pulmonary thromboembolism in Japanese patients hospitalized for medical illness: results of a multicenter registry in the Japanese society of pulmonary embolism research

Background: Although the prophylaxis of acute pulmonary thromboembolism (APTE) in hospitalized patients has been improving in Japan, there is no report concerning APTE of Japanese medical patients. Therefore, the present study was designed to investigate the characteristics of APTE in Japanese patients hospitalized for medical illness, through a retrospective study. Methods: In a total of 1,438 registry patients with pulmonary thromboembolism for recent 10 years, 1,027 patients with APTE were analyzed with respect to underlying diseases or predisposing factors, and clinical course. Results: A hundred thirty three patients hospitalized for medical illness developed APTE, among 433 in-hospital APTE patients. The prevalence of APTE in women was more than in men. The mean age of the patients at diagnosis was 61 ± 17 years. Main risk factors were a prolonged immobilization, stroke, cancer, indwelling central venous catheter. Fifty-four patients had 3 or more risk factors. In-hospital mortality rate was 23%. Conclusions: Japanese patients in this registry had almost the same findings as in western patients, except for some points that had the possibility of demonstrating a difference between westerners and Japanese in the development of APTE. Our results will be available for establishing the prevention of APTE in medical patients in Japan. The Japanese Society of Pulmonary Embolism Research (JaSPER) study investigators are listed in the Appendix.