58例急性肺栓塞治疗方案的选择与评估

目的 探讨急性肺栓塞（ＡＰＥ）的最佳治疗方案。评估重组组织型纤溶酶原激活剂和尿激酶（ＵＫ）２小时连续静脉溶栓法的可行性及临床疗效。方法 ５８例经放射性核素肺灌注通过扫描（ＥＣＴ）或选择性肺动脉造影（ＣＰＡ）确诊为ＡＰＥ的患者，采用ｒｔ－ＰＡ或ＵＫ２小时连续静脉滴注法（简称２小时法）或ＵＫ小剂量每日１次３￣７日法溶栓及单纯抗凝法，栓子切除法治疗。比较并分析不同治疗方案的临床疗效。结果 溶栓治疗４１例

Assessment of treatment regimens in 58 cases with acute pulmonary embolism

Objective To explore the best regimen of treatment for acute pulmonary embolism(APE),and to evaluate the efficacy and safety of 2-h infusion of recombinant tissue-type plasminogen activator,Alteplase (rt-PA)and urokinase(Uk). Methods Fifty-eight patients with APE diagnosed by perfusion lung scanning (ECT) or angiography(CPA)were treated with different regimens: i. e. 2-h infusion of rt-PA or UK (2-h group);low doses of [JK for 3 ~ 7 days (Qd group); anticoagulants alone and thromboectomy.The results were compared.Results Of the 41 patients treated with thrombolytic therapy 78% showed improvement in lung perfusion scan and clinical presentation without severe adverse effects, the percentage was significantly highe than tha of the anticoagulant group (P < 0.001). The rate of improvement was 84% if thrombolytic therapy was given in 2 h. The mortality rate was lower than anticoagulants and thromboectomy group.The success rate of thromboectomy was 40%. Conclusions A 2 h regimen of rt-PA or UK showed reliable efficacy and safety for treatment of APE. The indication of thrombolytic therapy can be extended.Mortality and morbidity could be reduced if thrombolytic therapy followed by anticoagulation is applied as early as possible.