瑞替普酶联合华法林在慢阻肺合并急性中危肺栓塞治疗中的有效性分析

目的 观察瑞替普酶(rPA)联合华法林在慢阻肺合并急性中危肺栓塞治疗中的有效性。方法 从近年诊治的慢阻肺合并急性中危肺栓塞的病例中随机挑选76例,分为研究组和对照组且每组病例数相同。研究组使用rPA联合华法林治疗,对照组使用低分子肝素钠序贯华法林治疗。比较治疗总有效率、血气分析、心肌损伤标志物水平、右/左心室最大短轴直径比(RVd/LVd)及不良反应。结果 研究组与对照组治疗有效率分别为94.7%和78.9%,差异有统计学意义(P＜0.05)；研究组PaO2、SaO2升高,PaCO2降低,与对照组比较差异有统计学意义(P＜0.05)；两组患者治疗后心肌损伤标志物水平及RVd/LVd均降低,组间比较差异有统计学意义(P＜0.05)；从各组患者采取溶栓抗凝治疗后开始观察,持续至疗程结束后60天,两组均未出现死亡病例,研究组患者中出现1例异常出血以及1例肺栓塞复发；对照组患者中出现6例异常出血以及3例肺栓塞复发。研究组患者异常出血较少,肺栓塞复发率也明显低于对照组(P＜0.05)。结论 瑞替普酶联合华法林治疗慢阻肺合并急性中危肺栓塞能有效改善症状,抑制心肌损伤,减少不良反应,更加安全有效。

Reteplase combined with warfarin in the treatment of COPD with acute intermediate-risk pulmonary embolism Effectiveness analysis

Objective to observe the effectiveness of reteplase (rPA) combined with warfarin in the treatment of COPD with acute intermediate-risk pulmonary embolism. Methods 76 cases of COPD with acute intermediate-risk pulmonary embolism diagnosed and treated in recent years were randomly selected and divided into a research group and a control group with the same number of cases in each group. The study group was treated with rPA combined with warfarin, and the control group was treated with low molecular weight heparin sodium sequential warfarin. Compare the total treatment efficiency, blood gas analysis, myocardial injury marker levels, right / left ventricular maximum short axis diameter ratio (RVd / LVd) and adverse reactions. Results The effective rates of treatment in the study group and the control group were 94.7% and 78.9%, respectively, the difference was statistically significant (P <0.05); PaO₂ and SaO₂ in the study group increased, and PaCO₂ decreased, which was statistically significant compared with the control group (P <0.05); After treatment, the levels of myocardial injury markers and RVd / LVd were reduced, and the difference between the groups was statistically significant (P <0.05); observation was started after thrombolytic anticoagulation treatment in each group of patients, continued By 60 days after the end of the treatment period, there were no deaths in both groups. There were 1 abnormal bleeding and 1 recurrence of pulmonary embolism in the study group; 6 abnormal bleeding and 3 recurrences of pulmonary embolism in the control group. Patients in the study group had less abnormal bleeding, and the recurrence rate of pulmonary embolism was also significantly lower than that in the control group (P <0.05). Conclusion Reteplase combined with warfarin in the treatment of COPD with acute intermediate-risk pulmonary embolism can effectively improve symptoms, suppress myocardial injury, reduce adverse reactions, and is more safe and effective.