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目的研究尿激酶溶栓联合抗凝在治疗下肢深静脉血栓(DVT)合并次大面积肺栓塞患者中的近期疗效。方法选取2012年10月—2015年10月金华市中心医院收治的下肢DVT合并次大面积肺栓塞患者108例,按照随机数表法分为对照组(54例)与观察组(54例),对照组行常规低分子肝素及华法林抗凝处理,观察组在常规抗凝基础上联合尿激酶溶栓处理,观察2组患者治疗后咳嗽、胸痛、呼吸困难缓解情况、双下肢周径差及疗效差异;比较治疗前后患者国际标准化比值(INR)、纤维蛋白原(FIB)、D-二聚体、血小板(PLT)、动脉血氧分压(PO2)及凝血指标PT、APTT、TT等,并进行统计学分析。结果治疗后2组患者双下肢周径差治明显小于治疗前(P<0.05);治疗后观察组周径差与对照组比较,差异有统计学意义(P<0.05);观察组下肢DVT疗效总效率(92.59%)明显高于对照组(75.93%)(P<0.05);肺栓塞疗效总有效率观察组高于对照组,差异有统计学意义(P<0.05);2组患者D-二聚体均有所下降,且观察组较对照组下降,差异有统计学意义(P<0.05);在INR、FIB、PLT、PO2比较上2组差异不明显(P>0.05);2组患者治疗后,PT、APTT、TT时间均低于治疗前(P<0.05);观察组PT、APTT、TT时间较对照组下降更为显著,差异有统计学意义(P<0.05)。结论尿激酶溶栓联合抗凝治疗下肢血栓合并次大面积肺栓塞患者中的近期疗效显著,值得在临床上推广运用。
Objective To study the short-term efficacy of urokinase thrombolysis combined with anticoagulation in the treatment of patients with deep venous thrombosis (DVT) and sub-maxillary pulmonary embolism. Methods A total of 108 patients with lower extremity DVT combined with large-area pulmonary embolism admitted from Jinhua Central Hospital from October 2012 to October 2015 were divided into control group (54 cases) and observation group (54 cases) according to random number table, The control group received routine low-molecular-weight heparin and warfarin anticoagulant treatment. The observation group was treated with conventional urokinase and urokinase thrombolysis. The relief of cough, chest pain, dyspnea, (INR), fibrinogen (FIB), D-dimer, PLT, PO2 and PT, APTT and TT in patients before and after treatment were compared Statistical analysis. Results After treatment, the differences of peripheral diameter between the two lower extremities in two groups were significantly less than those before treatment (P <0.05). After treatment, the differences in the diameter of the observation group were statistically significant (P <0.05) The total efficiency (92.59%) was significantly higher than that of the control group (75.93%) (P <0.05). The total effective rate of pulmonary embolism was higher in the observation group than in the control group (P <0.05) (P <0.05). There was no significant difference between the two groups in INR, FIB, PLT and PO2 (P> 0.05); while in the two groups, there was no significant difference between the two groups After treatment, PT, APTT and TT were all lower than those before treatment (P <0.05). PT, APTT and TT in the observation group were significantly lower than those in the control group (P <0.05). Conclusion Urokinase thrombolytic therapy combined with anticoagulation in the treatment of lower extremity thrombosis with sub-large pulmonary embolism in patients with short-term effect is significant, it is worth to promote the use of the clinic.