肺血栓栓塞症溶栓患者临床表现和疗效分析

目的分析96例肺血栓栓塞症(PTE)溶栓患者的临床特点,探讨该溶栓方案的有效性和安全性。方法分析96例接受溶栓的PTE患者的临床表现、实验室检查和影像学资料。Ⅰ组(62例)病程在2周内;Ⅱ组(26例)病程超过1个月,症状加重2周;Ⅲ组(8例)病程超过2周(最长呼吸困难史5个月),但影像学判断血栓较新鲜。采用尿激酶(75万~150万U)或重组组织型纤溶酶原激活剂(50~100mg)溶栓。综合判断溶栓疗效和安全性。结果74%PTE患者伴有下肢静脉疾患,96%有呼吸困难症状。溶栓后,呼吸频率、心率显著改善(P<0.001)。溶栓总有效率Ⅰ组97%;Ⅱ组73%(与Ⅰ组比较,P=0.001);Ⅲ组100%。结论下肢静脉病是PTE主要诱因,对于不能解释的劳力性呼吸困难、晕厥应高度怀疑PTE。

Thrombolytic therapy of pulmonary thrombo embolism: An analysis of treatment

Objective To analyze the clinical characteristics and the efficacy and safety of thrombolytic therapy in older patients with pulmonary thromboembolism(PTE). Methods The history, physical examination, laboratory examination, and imaging examination were evaluated in patients with PTE receiving thrombolytic therapy, and the efficacy and safety of thrombolytic therapy were estimated.Group Ⅰ included 62 patients who were presented < 14 days after the onset of symptoms;group Ⅱ included 26 patients who were presented > 1 months after the onset of symptoms and worsened <14 days;group Ⅲ included 8 patients who were presented > 14 days after the onset of symptoms (the longest course of dyspnea being 5 month) and the thrombus were fresh judged by imaging. Urokinase (750?000 U-1?500?000 U) and recombinant tissue-type plasminogen activator(50-100 mg) were administered as thrombolytic agents. Results Seventy-four percent of PTE patients had the complications of lower limb venous diseases(deep vein thrombosis, deep vein phlebitis, or lower limb varicosity), and dyspnea was present in 92 of 96 patients(96 percent).After receiving thrombolytic therapy, the patients were improved significantly in respiration rate and heart rate (P<0.001). The total effectiveness rate of thrombolytic therapy was 91% in group Ⅰ,73% in group Ⅱ (compared with group Ⅰ, P= 0.001) and 100% in group Ⅲ.Conclusion The lower limb venous disease is the main cause of PTE. PTE should be suspected in the patients with unexplainable exertional dyspnea and syncope.