急性肺血栓栓塞症规范化治疗的远期观察

目的探讨急性肺血栓栓塞症规范化治疗的远期疗效。方法对我院住院的32例急性PTE患者随机分溶栓组(18例)和抗凝组(14例),在抗凝与溶栓治疗后4、7、30及90d进行了随访观察,纪录溶栓或抗凝治疗前后临床症状、体征、血气分析及核素肺灌注/通气扫描(ECT)。结果两组在治疗后肺灌注缺损评分均较治疗前显著降低(P<0.01),溶栓组肺灌注缺损计分显著低于抗凝(P<0.05)。两组治疗前后PaO2及PaCO2后显著差异(P<0.01),两组间差异无显著性。结论溶栓治疗疗效优于抗凝治疗,具有溶栓指征的急性肺栓塞患者溶栓后4天血流灌注开始改善,1个月显著改善,3个月进一步改善,溶栓后的抗凝治疗防止肺栓塞的复发,有助于肺血流灌注的进一步恢复。

Observation of long term therapeutic effect of standardized treatment for acute pulmonary thromboembolism

Objective To discuss the long term therapeutic effect of standardized treatment for acute pulmonary thromboembolism.Methods Thirty-two inpatients of acute pulmonary thrombombolish were randomly divided into two groups: thrombolysis group and anticoagulant group.The therapeutic effect at the 4th,7th, 30th and 90th days after thrombolysis or anticoagulant treatment were observed. Clinical symptoms of physical examination,blood gas analysis and perfusion lung scanning(ECT) were recorded before and after thrombolysis or anticoagulant treatment.Results The score of lung perfusion coloboma of both groups decreased obviously after the treatment(P<0.01).The score difference of defective segmental lung before the therapy was not significant between the two groups(P>0.05).The score of lung perfusion coloboma for the thrombolysis group was obviously lower than that in the anticoagulant group(P<0.05).The difference of PaO2 and PaCO2 of both groups before and after the treatment was not significant(P>0.05).The difference before and after the treatment was significant(P<0.01).Conclusion Thrombolytic therapy is superior to anticoagulant therapy.After thrombolytic therapy,the short term(4 days) lung blood perfusion of the APE showed improvement.The lung blood perfusion improved significant after 1 month,and got more improvement after 3 months.Thrombolytic therapy is an effective method to APE.Anticoagulant therapy after thrombolytic treatment can prevent the recurrence of lung embolism,and it is beneficial to improvement of lung blood perfusion.