中危急性肺栓塞患者溶栓与单纯抗凝治疗的临床疗效分析

发布时间：2018-06-05 04:06

本文选题：中危 + 急性肺栓塞　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]探讨单纯抗凝与溶栓联合抗凝在中危急性肺血栓栓塞(acute pulmonary thromboembolism APTE)患者中的治疗应用及临床效果。[方法]选择2016年01月01日至2016年12月31日一年来就诊昆明医科大学附属第四医院云南省血管外科中心的中危APTE患者,患者入院后后告知患者单纯抗凝治疗及溶栓联合抗凝治疗两种方案,让患者自主选择并签署治疗同意书。选择单纯抗凝治疗的患者入A组(对照组)31例,选择溶栓联合抗凝治疗的患者入B组(实验组)35例,共计66例,根据患者治疗前后临床症状、复查肺动脉CTA、心脏彩超等评估治疗效果。[结果]1、治疗后两组患者的临床症状均得到不同程度的改善,分别比较二组患者治疗前后指标:肺栓塞面积(段数)减小,肺动脉收缩压(pulmonary artery systolic pressure PASP)下降,氧分压及氧饱和度也明显改善,差异有统计学意义(P0.05)。两组间治疗后指标改善程度比较,氧分压及氧饱和度差异无统计学意义(P0.05),肺栓塞面积(段数)及PASP差异有统计学意义(P0.05)。2、比较两组患者治疗后疗效,A组总有效率77.42%;B组总有效率97.15%,对比两组差异有统计学意义(P0.05)。3、两组患者出血并发症的比较,A组出血患者6例,出血发生率为19.35%;B组出血患者8例,出血发生率为22.86%。对比两组差异无统计学意义(P0.05)。[结论]1、对于中危APTE患者应用溶栓联合抗凝治疗与单纯抗凝治疗后临床症状均可得到改善。2、采用小剂量尿激酶溶栓联合抗凝治疗效果优于单纯抗凝治疗且并未增加出血风险。
[Abstract]:[objective] to investigate the application and clinical effect of anticoagulation combined with thrombolytic therapy in patients with acute pulmonary thromboembolism (pulmonary thromboembolism APTE). [methods] Intermediate risk APTE patients in Yunnan Provincial Vascular surgery Center, fourth affiliated Hospital of Kunming Medical University, from January 01, 2016 to December 31, 2016, were selected. After admission, patients were informed of only anticoagulant therapy and thrombolytic therapy combined with anticoagulant therapy. Patients with anticoagulant therapy were selected into group A (control group, 31 cases) and group B (group B, 35 patients with thrombolytic therapy combined with anticoagulant therapy). According to the clinical symptoms of the patients before and after treatment, The therapeutic effect was evaluated by reexamination of pulmonary artery CTAA and color Doppler echocardiography. [results] 1. After treatment, the clinical symptoms of the two groups were improved to varying degrees. The indexes before and after treatment were compared: pulmonary embolism area (number of segments) decreased, pulmonary systolic blood pressure (PAP) and pulmonary artery systolic pressure PASP) decreased. The oxygen partial pressure and oxygen saturation also improved obviously, the difference was statistically significant (P 0.05). Comparison of the degree of improvement of indexes after treatment between the two groups, There was no significant difference in oxygen partial pressure and oxygen saturation (P 0.05), but there was significant difference in pulmonary embolism area (number of segments) and PASP between two groups. The total effective rate of group A was compared with that of group A after treatment. The total effective rate of group B was 97.15%, and the difference between two groups was statistically significant. Comparison of bleeding complications in two groups A group (n = 6) had hemorrhage. The bleeding rate was 19.35% and 22.86% in group B. There was no significant difference between the two groups (P 0.05). [conclusion] 1. The clinical symptoms of moderate risk APTE patients were improved after thrombolysis combined with anticoagulant therapy and only anticoagulant therapy. The effect of low dose urokinase combined anticoagulant therapy was better than that of simple anticoagulant therapy and did not increase the risk of bleeding.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.5

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