急性肺血栓栓塞症溶栓及抗凝治疗多中心临床分析

目的 分析急性肺血栓栓塞症（PTE）患者的临床资料并观察溶栓和抗凝治疗的疗效。方法 收集患得的病史,浆确诊的127例急性PTE患者分为3组,A组患者予以尿激酶2万U/kg溶于生理盐水100ml中,静脉滴注,2h滴完,溶栓结束后,每4h检测一次激活的部分凝血活酶时间或激活的全血凝固时间,待其恢复至基础值的1.5-2.0倍以内,开始予以皮下注射低分子量肝素0.4ml,每12h一次,共7d,并重叠口服华法林4-5d,尔后单纯应用华法林,初使剂量为3mg,再根据国际标准化比率调整华法林剂量,直至INR达到2-3,B组患者只用尿激酶静脉溶栓而不同低分子量肝素抗凝,并口服华法林,尿激酶及华法林的用法同A组,C组患者予以皮下注射低分子量肝素0.4ml,每12h一次,共7d,并重叠口服华法林,华法林的用法同A组,治疗前后以临床表现及核素肺灌注显像或CT或肺动脉造影检查进行对比分析。观察其疗效,结果 127例患者最常见的易患因素是深静脉血栓形成,临床症状以呼吸困难最为常见,其次是咳嗽,胸痛、咯血和晕厥。70例用尿激酶溶栓和低分子量肝素抗凝治疗者,有效率为90.0%,有2例患者发生轻度出血;31例单用尿激酶溶栓者,有效率为77.4%,有1例患者发生轻度出血;26例单用低分子量肝素抗凝治疗者,有效率为61.5%,有1例患者发生轻度出血,尿激酶溶栓总有效率为86.1%,症状出现后1周内进行溶栓效果最好（92.7%),2周以上也有一定疗效（81.8%)。结论 联合应用尿激酶溶栓和低分子量肝素抗凝治疗急性PTE安全、有效。

Multicenter clinical trial on the efficacy of thrombolytic therapy with urokinase and/or anticoagulant with low molecular weight heparin in acute pulmonary embolism

Objective To evaluate the efficacy of thrombolytic therapy with urokinase and/or anticoagulant with low molecular weight heparin in patients with acute pulmonary embolism.Methods 127 patients with documented acute pulmonary embolism were treated with different regimens: thrombolysis combined with anticoagulant theraphy in 70 cases, thrombolytic therapy alone in 31 cases and pure anticoagulant therapy in 26 cases.Results Dyspnea was the most common symptom(91.3%), then cougth (74.0%), chest pain(63.0%) and syncope (21.3%). As compared with pre-treatment in each group, there was significant improvement in respiratory rate, heart rate, partial pressure of oxygen in artery and partial pressure of carbon dioxide in artery. The effective rate of thrombolysis combined with anticoagulant therapy, thrombolytic therapy and anticoagulant therapy were 90.0%, 77.4% and 61.5%, respectively, the total effective rate of thrombolytic therapy was 86.1%.The best efficacy was demonstrated in patients within one week after onsent of symptoms. The therapy might be effective for cases with duration longer than two weeks after the onset of symptoms.Conclusion Thrombolytic therapy with urokinase combined with low molecular weight heparin is effective and safe for acute pulmonary embolism.