豁痰祛瘀方联合大剂量rt-PA溶栓治疗急性肺栓塞临床研究

目的:观察豁痰祛瘀方联合大剂量重组织型纤溶酶原激活剂(recombinant tissue-type plasminogen activator,rt-PA)溶栓治疗急性肺栓塞的临床疗效,并观察对中医证候积分、血气分析指标、肿瘤坏死因子-α(tumor necrosis factor-alpha,TNF-α)、D-二聚体水平的影响。方法:142例急性肺栓塞患者按抽签方式分为对照组(n=71)与观察组(n=71)。对照组患者给予大剂量rt-PA溶栓治疗,观察组在对照组基础上给予豁痰祛瘀方。比较治疗前后两组血气分析(PaCO_2、PaO_2)、临床证候积分、TNF-α、D-二聚体的水平,并评价两组患者临床疗效。结果:观察组有效率为94.37%(67/71),明显高于对照组的81.69%(58/71),差异具有统计学意义(P0.05)。治疗后,观察组中医证候积分为(9.36±1.55)分,对照组中医证候积分为(15.64±1.47)分,两组比较,差异有统计学意义(P0.05)。治疗后,对照组PaCO_2、PaO_2分别为(33.52±1.26)mm Hg(1 mm Hg=0.133 k Pa)、(75.63±1.67)mm Hg,观察组PaCO_2、PaO_2分别为(37.21±1.33)mm Hg、(80.24±1.87)mm Hg,两组比较,差异均有统计学意义(P0.05)。治疗后,对照组TNF-α、D-二聚体分别为(4.35±1.42)μg·L~(-1)、(486.52±121.42)μg·L~(-1),观察组分别为(2.52±0.87)μg·L~(-1)、(425.63±102.35)μg·L~(-1),两组比较,差异均有统计学意义(P0.05)。结论:豁痰祛瘀方联合大剂量rt-PA溶栓治疗急性肺栓塞,可显著提高临床疗效,缓解临床症状,提高血气分析指标,降低TNF-α、D-二聚体的水平。

Clinical Study on Huotan Quyu Decoction Combined with Large Doses of rt-PA Thrombolysis in the Treatment of Acute Pulmonary Embolism

Objective:To investigate the clinical efficacy of Huotan Quyu decoction combined with large doses of recombinant tissue-type plasminogen activator (rt-PA) thrombolysis in the treatment of acute pulmonary embolism (APE) and its influence on TCM syndrome integral,blood gas analysis index,tumor necrosis factor-alpha(TNF-α） and D-Dimer level.Methods:142 cases of APE patients were divided into control group(n =71) and observation group by draw lots.Control group took large doses of rt-PA thrombolysis and observation group took Huotan Quyu decoction on the basis of control group.The arterial blood gas analysis (PCO2,PO2),clinical symptom,TNF-α,D-Dimer level of two groups before and after treatment were compared,and clinical efficacy of two groups were evaluated.Results:The effective rate of observation group was 94.37％ (67/71),which was significantly higher than 81.69％ (58/71) of control group (P ＜ 0.05);after treatment,TCM syndrome integral of the observation group was (9.36 ± 1.55) points,the control group was (15.64 ± 1.47),the difference was statistically significant (P ＜ 0.05).After treatment,PCO2,PO2 of the control group respectively were (33.52 ± 1.26) mm Hg (1 mm Hg =0.133 kPa),(75.63 ± 1.67) mm Hg,and the observation group were respectively (37.21 ± 1.33) mm Hg,(80.24 ± 1.87) mm Hg,the differences were statistically significant (P ＜ 0.05).After treatment,TNF-α,D-two dimers of the control group were (4.35 ± 1.42) μg · L-1,(486.52 ± 121.42) μg · L-1,and the observation group respectively (2.52 ±0.87) μg · L-1,(425.63 ± 102.35) μg · L-1,and the differences were statistically significant (P ＜ 0.05).Conclusion:Huotan Quyu decoction combined with large doses of rt-PA thrombolysis for treating APE can effectively improve clinical efficacy,relieve clinical symptom and improve blood gas analysis index,reduce the level of TNF-α alpha and D-Dimer two dimer level.