论文部分内容阅读
目的:分析136例肺血栓栓塞症(PTE)溶栓患者的临床特点,探讨该溶栓方案的有效性和安全性。方法:分析1990年1月~2006年5月间我院136例接受溶栓的肺栓塞患者的临床表现、实验室检查和影像学资料。Ⅰ组(85例)病程在2周内;Ⅱ组(39例)病程>1个月,症状加重2周内;Ⅲ组(12例)病程和症状加重>2周,但增强计算机断层摄影术判断血栓较新鲜。根据患者情况采用不同剂量如尿激酶(75万U~150万U)或重组组织型纤溶酶原激活剂(50~100mg)溶栓。综合判断溶栓疗效和安全性。结果:76%PTE患者伴有下肢静脉疾患,96%有呼吸困难症状,21%有晕厥史。溶栓后,呼吸频率、心率较溶栓前显著改善(P<0.001)。溶栓总有效率Ⅰ组96%;Ⅱ组77%(与Ⅰ组比较,P=0.001);Ⅲ组100%。溶栓并发症:较大出血3例,其中2例为穿刺点渗血,1例为上消化道出血,无颅内出血及死亡发生。结论:下肢静脉病是PTE主要诱因,对于不能解释的劳力性呼吸困难、晕厥应高度怀疑PTE。PTE的治疗应个体化,溶栓越早越好。该溶栓方案疗效好,出血并发症少。
Objective: To analyze the clinical features of 136 patients with pulmonary thromboembolism (PTE) thrombolytic therapy and explore the effectiveness and safety of the thrombolytic therapy. Methods: The clinical manifestations, laboratory tests and imaging data of 136 patients undergoing thrombolysis in our hospital from January 1990 to May 2006 were analyzed. Group Ⅰ (85 cases) course of disease within 2 weeks; Group Ⅱ (39 cases) course of disease> 1 month, within 2 weeks of exacerbations; Group Ⅲ (12 cases) course of disease and symptoms worsened> 2 weeks, but enhanced computerized tomography Judging the thrombus more fresh. According to the patient’s condition with different doses of urokinase (750,000 U ~ 1.5 million U) or recombinant tissue plasminogen activator (50 ~ 100mg) thrombolysis. Comprehensive judgment of thrombolytic efficacy and safety. RESULTS: Sixty-six percent of PTE patients had venous venous disease, 96% had dyspnea, and 21% had a history of syncope. After thrombolysis, respiratory rate and heart rate were significantly improved compared with those before thrombolysis (P <0.001). The total effective rate of thrombolytic group Ⅰ 96%; Ⅱ 77% (compared with group Ⅰ, P = 0.001); Ⅲ group 100%. Thrombolytic complications: 3 cases of major bleeding, of which 2 cases of puncture point bleeding, 1 case of upper gastrointestinal bleeding, no intracranial hemorrhage and death. Conclusion: Venous venous disease of the lower extremities is the main cause of PTE. PTE should be highly suspected for unexplained exertional dyspnea and syncope. PTE treatment should be individualized, the sooner the better thrombolysis. The thrombolytic effect of the program, less bleeding complications.