单纯抗凝与导管内溶栓加抗凝治疗肺动脉栓塞疗效对比分析

目的评价单纯抗凝与导管内溶栓加抗凝治疗肺动脉栓塞疗效对比。方法经肺动脉造影或增强螺旋CT证实的急性肺动脉栓塞患者63例，随机分两组，一组单纯肝素抗凝32例，另一组导管内尿激酶溶栓加肝素抗凝31例。结果单纯抗凝治疗总有效率96．7％；导管内溶栓加抗凝治疗总有效率100％，但临床症状改善较快。单纯抗凝无效1例，经导管内溶栓后好转。经导管内溶栓出现消化道出血1例。本观察无1例死亡。结论单纯抗凝与导管内溶栓加抗凝治疗总有效率相近，无并发症出现。所以对无血液动力学改变的急性肺动脉栓塞单纯肝素抗凝即可取得确切疗效，可降低风险。

Evaluation of effect of pure anticoagulation and catheter-directed adminstration of intraembolic thrombolytic therapy combined with anticoagulation in treatment of pulmonary embolism

Objective To evaluate the therapeutic effect of pure anticoagulation and catheter directed adminstration of intraembolic thrombolytic therapy(ITH)combined with anticoagulation in treatment of pulmonary embolism(PE) Methods 63 patients who were proved to be acute PE by pulmonary arteriography and/or spiral CT were randomly divided into two groups Control group(C group)32 cases,pure anticoagulation with heparin Treatment group(T group)31 cases with catheter directed adminstration of intraembolic thrombolytic therapy combined with heparin Result The total effective rate of C group was 96 7%,that in T group was 100%,but symptom improvement in T group was faster than in C group Therapeutic ineffective patient was only one case in C group,this case was inproved by catheter directed adminstration of intraembolic thrombolytic therapy The major complication is hemorrhage,there was one case in T group of gastric hemorrhage,no dead patient in two groups Conclusion Effective rate in two group was no significant difference,three was no complication in C group If patient of acute PE has no hemodynamic change,pure anticoagulation is effective and hemorrhage risk is lower than catheter directed adminstration of intraembolic thrombolytic therapy(ITH)combined with anticoagulation