溶栓與抗凝治療急性次大面積肺血栓栓塞癥的療效和安全性比較_《中國呼吸與危重監護雜志》

作者：

宗華 ,  朱光發 , 梁瑛

首都醫科大學附屬北京安貞醫院呼吸內科（北京 100029）;

關鍵詞：

目的探討溶栓與抗凝治療對急性次大面積肺血栓栓塞癥( PTE) 患者的療效與安全性。方法回顧分析符合入選標準的84 例次大面積PTE 患者的臨床資料, 溶栓組49 例, 單純肝素抗凝組( 抗凝組) 35 例, 以治愈、顯效、進步、無效、惡化和死亡6 級判斷標準進行療效評價, 以治愈+ 顯效+ 進步為有效, 計算有效率, 以惡化+ 死亡計算嚴重事件發生率, 統計出血并發癥。結果溶栓組臨床有效率為81. 6%, 顯著高于抗凝組的54. 3% ( P = 0. 007) 。溶栓組惡化1 例, 無死亡病例抗凝組惡化4 例, 死亡1例, 兩組嚴重事件發生率分別為2. 0% 和14. 3% , 差異有統計學意義( P = 0. 032) 溶栓組和抗凝組出血發生率分別為20. 4% 和14. 3% , 差異無統計學意義( P > 0. 05) , 且主要為皮下或穿刺點出血, 兩組均未出現嚴重出血病例。結論急性次大面積PTE 患者, 在無溶栓絕對禁忌證的情況下, 可首選溶栓治療, 以迅速逆轉右心功能不全, 改善患者臨床癥狀和近期預后。

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肺血栓栓塞癥; 右室功能不全; 溶栓療法; 抗凝療法

引用本文： 宗華,朱光發,梁瑛. 溶栓與抗凝治療急性次大面積肺血栓栓塞癥的療效和安全性比較. 中國呼吸與危重監護雜志, 2009, 09(1): 48-51. doi: 復制

1.	中華醫學會呼吸病分會. 肺血栓栓塞癥的診斷與治療指南( 草案) . 中華結核和呼吸雜志, 2001, 24: 259-264.
2.	Buller HR, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest, 2004, 126 :S401-S428.
3.	Thabut G, Logeart D. Thrombolysis for Pulmonary Embolism in Patients With Right Ventricular Dysfunction Con. Arch Intern Med,2005, 165, 2200-2203.
4.	Goldhaber SZ. Thrombolytic Therapy for Patients With Pulmonary Embolism Who Are Hemodynamically Stable But Have Right Ventricular Dysfunction Pro. Arch Intern Med, 2005, 165, 2197-2199.
5.	張蘊, 楊媛華, 龐寶森, 等. 急性肺血栓栓塞患者血清轉氨酶的變化. 中華急診醫學雜志, 2007, 16: 859-863.
6.	康健, 王辰, 陸慰萱, 等. 專家討論會: 肺血栓栓塞癥. 中國實用內科學雜志, 2006, 26 : 1457 -1465.
7.	Kreit JW. The impact of right ventricular dysfuction on the prognosis and therapy of normotensive patients with pulmonary embolism. Chest, 2004, 125: 1539-1545.
8.	楊京華, 梁瑛, 胡尚基, 等. 急性肺血栓栓塞癥溶栓治療的遠期觀察. 中華結核呼吸雜志, 2001, 24: 753.
9.	何建國, 程顯聲, 高明哲, 等. 全國21 家醫院急性肺栓塞診治情況的調查分析. 中華醫學雜志, 2001, 81: 1490-1492.
10.	Kucher N, Rossi E, De Rosa M, et al. Prognostic role of echocardiography among patients with acute pulmonary embolism and preserved systemic arterial pressure. Arch Intern Med, 2005, 165: 1777-1781.
11.	Schoepf UJ, Kucher N, Kipfmueller F, et al. Right ventricular enlargement on chest computed tomography: a predictor of early death in acute pulmonary embolism. Circulation, 2004, 110: 3276-3280.
12.	Konstantinides S, GeibelA, Heusel G, et al. Heparin plus alteplase compered with heparin alone in patients with submassive-pulmonary embolism. N Engl JMed, 2002, 347: 1143-1150.
13.	Wan S, Quinlan DJ, Agnelli G, et al. Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: a meta-analysis of the randomized controlled trials. Circulation, 2004 , 110 :744 -749.
14.	Hamel E, Pacouret G, Vincentelli D, et al. Thrombolysis or heparin therapy in massive pulmonary embolism with right ventricular dilation.Chest, 2001, 120: 120-125.
15.	Mikkola KM, Patel SR, Parker JA, et al. Increasing age is a major risk factor for hemorrhagic complications after pulmonary embolism thrombolysis. Am Heart J, 1997, 134: 69-72.

1. 中華醫學會呼吸病分會. 肺血栓栓塞癥的診斷與治療指南( 草案) . 中華結核和呼吸雜志, 2001, 24: 259-264.
2. Buller HR, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest, 2004, 126 :S401-S428.
3. Thabut G, Logeart D. Thrombolysis for Pulmonary Embolism in Patients With Right Ventricular Dysfunction Con. Arch Intern Med,2005, 165, 2200-2203.
4. Goldhaber SZ. Thrombolytic Therapy for Patients With Pulmonary Embolism Who Are Hemodynamically Stable But Have Right Ventricular Dysfunction Pro. Arch Intern Med, 2005, 165, 2197-2199.
5. 張蘊, 楊媛華, 龐寶森, 等. 急性肺血栓栓塞患者血清轉氨酶的變化. 中華急診醫學雜志, 2007, 16: 859-863.
6. 康健, 王辰, 陸慰萱, 等. 專家討論會: 肺血栓栓塞癥. 中國實用內科學雜志, 2006, 26 : 1457 -1465.
7. Kreit JW. The impact of right ventricular dysfuction on the prognosis and therapy of normotensive patients with pulmonary embolism. Chest, 2004, 125: 1539-1545.
8. 楊京華, 梁瑛, 胡尚基, 等. 急性肺血栓栓塞癥溶栓治療的遠期觀察. 中華結核呼吸雜志, 2001, 24: 753.
9. 何建國, 程顯聲, 高明哲, 等. 全國21 家醫院急性肺栓塞診治情況的調查分析. 中華醫學雜志, 2001, 81: 1490-1492.
10. Kucher N, Rossi E, De Rosa M, et al. Prognostic role of echocardiography among patients with acute pulmonary embolism and preserved systemic arterial pressure. Arch Intern Med, 2005, 165: 1777-1781.
11. Schoepf UJ, Kucher N, Kipfmueller F, et al. Right ventricular enlargement on chest computed tomography: a predictor of early death in acute pulmonary embolism. Circulation, 2004, 110: 3276-3280.
12. Konstantinides S, GeibelA, Heusel G, et al. Heparin plus alteplase compered with heparin alone in patients with submassive-pulmonary embolism. N Engl JMed, 2002, 347: 1143-1150.
13. Wan S, Quinlan DJ, Agnelli G, et al. Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: a meta-analysis of the randomized controlled trials. Circulation, 2004 , 110 :744 -749.
14. Hamel E, Pacouret G, Vincentelli D, et al. Thrombolysis or heparin therapy in massive pulmonary embolism with right ventricular dilation.Chest, 2001, 120: 120-125.
15. Mikkola KM, Patel SR, Parker JA, et al. Increasing age is a major risk factor for hemorrhagic complications after pulmonary embolism thrombolysis. Am Heart J, 1997, 134: 69-72.

《中國呼吸與危重監護雜志》

溶栓與抗凝治療急性次大面積肺血栓栓塞癥的療效和安全性比較

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《中國呼吸與危重監護雜志》

溶栓與抗凝治療急性次大面積肺血栓栓塞癥的療效和安全性比較

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