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目的研究小剂量组织型纤溶酶原激活物阿替普酶联合尿激酶治疗急性肺动脉栓塞的临床疗效及安全性。方法将46例急性肺动脉栓塞患者随机分为两组,A组22例,第1天阿替普酶20 mg加尿激酶60万U溶栓,第2~5天尿激酶60万U/d;B组24例,第1天尿激酶首剂40 000 U/kg,30 min内静脉注射,然后120万U溶栓,第2~5天尿激酶60万U/d;观察两组溶栓效果及并发症。结果 A组溶栓显效14例,有效5例,无效3例,总有效率为86.36%;B组溶栓显效9例,有效11例,无效4例,总有效率为83.33%;两组有效率比较差异未见统计学意义(P>0.05),但两组显效率比较差异有统计学意义(P<0.05);溶栓后第1天两组患者肺动脉压、动脉血氧分压比较差异有统计学意义(P<0.05);溶栓后3、5 d两组患者肺动脉收缩压、动脉血氧分压比较差异未见统计学意义(P>0.05)。除血尿及置管处渗血,未见严重的不良反应,A组渗血1例,B组血尿2例,两组比较差异未见统计学意义(P>0.05)。B组24 h死亡1例,其余患者无死亡。结论溶栓治疗急性肺动脉栓塞有效,早期溶栓可以降低病死率;小剂量阿替普酶结合尿激酶治疗急性肺动脉栓塞安全有效,优于单纯尿激酶治疗。
Objective To study the clinical efficacy and safety of low-dose tissue plasminogen activator alteplase combined with urokinase in the treatment of acute pulmonary embolism. Methods Forty-six patients with acute pulmonary embolism were randomly divided into two groups: group A (n = 22) with 20 mg of alteplase and 600,000 U of urokinase on day 1 and 600,000 U / d of urine urokinase on day 2 to 5; Group B, 24 cases, the first day of urokinase 40 000 U / kg, intravenous injection within 30 min, and then 1.2 million U thrombolytic, 2 to 5 days Urokinase 600 000 U / d; observed two groups of thrombolytic effect And complications. Results In group A, the thrombolysis was effective in 14 cases, effective in 5 cases and ineffective in 3 cases, with a total effective rate of 86.36%. In group B, the thrombolysis was effective in 9 cases, effective in 11 cases and ineffective in 4 cases. The total effective rate was 83.33% There was no significant difference in efficiency between two groups (P> 0.05), but there was significant difference between the two groups (P <0.05). On the first day after thrombolysis, pulmonary arterial pressure and arterial partial pressure of oxygen were significantly different (P <0.05). There was no significant difference in pulmonary artery systolic pressure and arterial partial pressure of oxygen between the two groups on the 3rd and 5th day after thrombolysis (P> 0.05). In addition to hematuria and catheter leakage, no serious adverse reactions, 1 case of bleeding in group A, 2 cases of hematuria in group B, the two groups showed no significant difference (P> 0.05). One patient died in 24 h in group B, and the other patients did not die. Conclusion Thrombolytic therapy of acute pulmonary embolism effective early thrombolysis can reduce mortality; low-dose combination of alteplase and urokinase in the treatment of acute pulmonary embolism safe and effective, superior to urokinase treatment alone.