尿激酶与瑞替普酶在肺动脉栓塞中的治疗效果及安全性评价

目的探讨尿激酶和瑞替普酶在治疗肺动脉栓塞中的效果和安全性。方法选取2009年4月至2012年4月在我院治疗的51例肺动脉栓塞患者作为研究对象,随机分为2组。研究组32例,给予瑞替普酶;对照组19例,采用尿激酶溶栓治疗。观察溶栓前后患者肺动脉压(PAP)、动脉氧分压(PaO2)、血压(SBP)及出血并发症情况。结果治疗后,研究组总有效率为90.6%,对照组为73.7%,两组比较差异有统计学意义(P<0.05);两组患者PAP降低,PaO2、SBP上升,治疗前后比较差异有统计学意义(P<0.05)。两组患者主要不良反应包括牙龈出血、咯血、消化道出血、穿刺点出血及寒战等,且研究组牙龈出血、咯血和穿刺点出血等不良反应发生率明显低于对照组,两组比较差异有统计学意义(P<0.05)。结论瑞替普酶治疗肺动脉栓塞效果明显优于尿激酶,且出血发生率较低,值得临床推广。

Evaluation of the therapeutic effect and safety of urokinase and reteplase in the treatment of pulmonary embolism

Objective To explore the efficacy and safety of urokinase and reteplase in the treatment of pulmo- nary embolism. Methods 51 patients with pulmonary artery embolism from April 2009 to April 2012 in our hospital were selected as research objects, they were randomly divided into 2 groups, study group（ n = 32）was treated with reteplase, control group（ n = 19 ） was given urokinase thrombolytic. The PAP, PaO2 , SBP and bleeding complications of patients were recorded before and after thrombolytic therapy. Results After treatment, the total effective rate in study group was higher than that of control group（90.6% vs. 73.7% ,P 〈 0.05 ） ;the PAP of the two groups decreased sig- nificantly （ P 〈 0.05 ）, PaO2 and SBP increased significantly （ P 〈 0.05 ） ; Gingival bleeding, hemoptysis, gastrointestinal bleeding, puncturing site bleeding and shilvering were the main adverse reactions. The incidence of adverse reaction in study group was lower than that of control group （ P 〈 0.05 ）. Conclusion The effect of reteplase on pulmonary embolism is obviously better than that of urokinase, with lower bleeding rate,it is worth the clinical promotion.