阿替普酶溶栓联合低分子肝素钙及华法林抗凝治疗中高危肺栓塞的有效性及安全性

目的 观察阿替普酶溶栓治疗联合低分子肝素钙与华法林抗凝治疗中高危(急性次大面积)肺栓塞的有效性及安全性.方法 选取2017年5月-2019年5月南华大学附属长沙中心医院收治的中高危(急性次大面积)肺栓塞患者129例,根据平行对比法分为观察组(65例)和对照组(64例).在常规综合治疗基础上,对照组给予低分子肝素钙联合华...

Efficacy and safety of alteplase thrombolysis combined with low molecular weight heparin calcium and warfarin in the treatment of middle and high risk pulmonary embolism

Objective To observe the efficacy and safety of alteplase thrombolytic therapy combined with low molecular weight heparin calcium and warfarin in the treatment of middle and high risk(acute sub large area)pulmonary embolism.Methods From May 2017 to May 2019,129 patients with moderate to high risk(acute sub large area)pulmonary embolism were selected.According to parallel comparison method,they were divided into observation group(65 cases)and control group(64 cases).On the basis of conventional comprehensive treatment,the control group was treated with low molecular weight heparin calcium combined with warfarin,and the observation group was treated with alteplase thrombolytic sequential therapy on the basis of the control group.The indexes of echocardiography(RVESVI and RVEDVI),indexes of coagulation,fibrinolysis and vascular injury(D-D,PS,PC,TM,AT-Ⅲ,PAI-1,t-PA)and adverse reactions were compared between the two groups after treatment.Results After treatment,RVESVI and RVEDVI of the observation group were better than those of the control group(P<0.01);The indexes of coagulation,fibrinolysis and vascular injury in the observation group were better than those in the control group(P<0.01 or P<0.05);The total incidence of adverse reactions in the observation group was4.62%,which was lower than 17.19%in the control group(χ²=5.268,P=0.022).Conclusion Alteplase sequential thrombolysis combined with low molecular weight heparin calcium and warfarin anticoagulation in the treatment of middle and high risk(acute sub large area)pulmonary embolism can improve right heart failure and delay the progress of right heart failure.It can improve the balance of coagulation and fibrinolysis and alleviate the degree of vascular endothelial injury,and will not increase the possibility of bleeding in patients with high safety,which is worthy of popularization and application.