阿替普酶治疗中高危肺栓塞的临床疗效分析

目的评价阿替普酶溶栓治疗中高危肺栓塞患者的有效性及安全性。方法我院呼吸科收治的经肺动脉CTA确诊的肺栓塞患者39例,给予阿替普酶50 mg缓慢静点2 h后,观察溶栓前及溶栓24 h后的临床表现、心肌损伤标记物变化,氧合指数及溶栓治疗后5～7 d心脏超声,溶栓治疗后7～14 d肺动脉CTA的变化,并评估溶栓后出血并发症的发生情况。结果溶栓治疗后24 h,CK-MB异常者的比例较溶栓前明显降低(P=0.047),肌钙蛋白TnI异常者的比例较溶栓前亦明显降低(P<0.001)。溶栓后平均氧合指数较溶栓前明显改善(P<0.001)。溶栓治疗的总体有效率为89.5%(34/38),高危、中危患者的有效率分别为94.1%(16/17)、85.71%(18/21)。出现并发症7例,其中5例为桡动脉或股动脉血气分析采血处的血肿,2例为便潜血阳性。结论应用50 mg阿替普酶2 h静脉滴注治疗中高危急性血栓性肺栓塞疗效确切,安全性较高。

Clinical efficacy of alteplase on pulmonary embolism of the high and moderate risk patients

Objective To evaluate the efficacy and safety of alteplase on pulmonary embolism of the high and moderate risk patients.Methods 39 patients with pulmonary embolism in respiratory department of our hospital were given alteplase(50 mg)treatment.The observed indexes were as follows:clinical manifestations,cardiac injury index,oxygenation index before and 24 h after thrombolysis;the performance of echocardiography before and 5~7 d after thrombolysis;CT pulmonary angiography before and 7~14 d after thrombolysis;complications of bleedings after thrombolysis.Results 24 h after the thrombolysis,the ratio of abnormal CK-MB and TnI reduced significantly(P=0.047,P<0.001),and the mean oxygenation index was improved(P<0.001).The efficiency rate of thrombolysis by alteplase to high risk patients was 94.1%(16/17);to moderate risk patients,it was 85.71%(18/21);the total efficiency rate was 89.5%(34/38).There were 7 cases with complications(5 cases of hematoma in the sites of blood gas analysis on radial or femoral arterial,2 cases of positive fecal occult blood).Conclusion The thrombolysis of 50 mg alteplase for pulmonary embolism patients with high to moderate risk is efficient and safe.