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目的观察阿替普酶联合低分子肝素治疗急性肺血栓栓塞症的临床效果及安全性。方法回顾性分析2012年1月~2015年8月我院重症医学科收治的54例急性PTE患者,45例应用阿替普酶联合低分子肝素治疗,9例应用尿激酶联合低分子肝素治疗,观察两组疗效及并发症。结果观察组有效42例,无效3例,其中2例并发脑出血死亡,对照组有效6例,无效3例,其中1例并发脑出血死亡,两组治疗效果有显著性差异(P<0.05);但脑出血的发生率无显著性差异(P>0.05)。溶栓效果与发生肺栓塞的时间有关,时间越短,溶栓效果越好(P<0.05)。结论阿替普酶联合低分子肝素治疗急性PTE效果肯定,但同尿激酶一样可出现出血的并发症,尤其是脑出血。如果溶栓后出现头痛,且逐渐出现神志改变,有可能发生脑出血,要注意观察,一旦发生预后不良。
Objective To observe the clinical effect and safety of alteplase combined with low molecular weight heparin in the treatment of acute pulmonary thromboembolism. Methods A retrospective analysis of 54 cases of acute PTE admitted to our department from January 2012 to August 2015 in our hospital was conducted. 45 cases were treated with alteplase and low molecular weight heparin, 9 cases were treated with urokinase combined with low molecular weight heparin, The curative effect and complications of two groups were observed. Results In the observation group, 42 cases were effective and 3 cases were ineffective. Among them, 2 cases died of intracerebral hemorrhage, 6 cases were effective and 3 cases were ineffective in the control group. One case died of intracerebral hemorrhage and the therapeutic effect was significant difference (P <0.05) ; But there was no significant difference in the incidence of cerebral hemorrhage (P> 0.05). Thrombolytic effect and the occurrence of pulmonary embolism time, the shorter the time, the better thrombolytic effect (P <0.05). Conclusion Alteplase combined with low molecular weight heparin in the treatment of acute PTE positive effect, but the same with urokinase bleeding complications may occur, especially cerebral hemorrhage. If there is a headache after thrombolysis, and gradual emergence of mind changes, cerebral hemorrhage may occur, pay attention to observation, in the event of poor prognosis.