阿替普酶治疗急性肺栓塞的初步研究

目的:评价在急性肺血栓栓塞症(PTE)治疗中使用阿替普酶(rt-PA)的方法、安全性和有效性。方法:按照实验设计,于2010-07-2012-06间将20例中重度急性期肺血栓栓塞症患者,随机分成导管接触溶栓组(10例,留置导管于肺动脉血栓处,2h内持续导管泵入阿替普酶50mg)、外周静脉溶栓组(10例,15mg静脉推注,其余35mg滴注2h)。分析治疗前后患者血气分析、超声心动图、肺动脉CTA等检查结果的变化情况。结果:20例患者溶栓1d及5d后,其呼吸困难症状均有所改善,但两组间部分检查指标比较差异有统计学意义。结论:阿替普酶治疗急性期肺血栓栓塞症,在相同剂量、相同使用时间的情况下对比导管接触溶栓与外周静脉溶栓,临床治疗短期表现前者优于后者。所以我们认为在临床上采用阿替普酶导管接触溶栓治疗是安全的、效果优于传统的外周静脉用法。

A preliminary study on alteplase in the treatment of acute pulmonary thromboembolism

Objective：To evaluate the safety and effects of applying aheplase on treatement for acute pulmonary thromboembolism （PTE）. Method： 20 cases of patients with moderate to severe acute pulmonary thromboembo- lism were selected from the hospital from July 2010 to June 2012 and were randomly divided into two groups. In 10 cases of catheter directed thrombolytic therapy group,a catheter was indwelt where the pulmonary arterial throm- bosis occurred and 50 mg of alteplase was pumped through the catheter continuously for two hours. In peripheral venous thrombolytic therapy group, 15 mg of alteplase was intravenous injected and the remaining 35 mg was intra- venous infused for two hours. Changes in the results of blood gas analysis,eehocardiogram, and CT angiography of pulmonary artery of the patients before and after the treatment were analyzed. Result： After one day and five days of treatment,the dyspnea symptoms were relieved for 20 patients in both groups, but the difference between some of the comparing indexes had statistical significance. Conclusion：When the same dose of alteplase was used for the same duration in treating acute pulmonary thromboembolism,catheter directed thrombolytic therapy was superior to peripheral venous thrombolytic therapy in short-term clinical outcomes. Therefore,we believe that it is safe to apply catheter directed thrombolytic therapy with alteplase in treating acute pulmonary thromboembolism,and the effect of which is better than the traditional peripheral venous thrombolytic therapy.