溶栓加抗凝疗法与单纯抗凝疗法对中危组急性肺血栓栓塞症的疗效分析

发布时间：2018-07-07 07:25

本文选题：急性肺血栓栓塞症 + 尿激酶　；参考：《广西医科大学》2013年硕士论文

【摘要】：目的：探讨溶栓加抗凝疗法与单纯抗凝疗法对中危组急性肺血栓栓塞症(PTE)患者的治疗效果,以提高临床对该病的认识,提高诊疗水平,降低该病的死亡率。方法：收集广西医科大学第一附属医院2010年1月至2012年12月期间确诊为中危组的急性肺栓塞患者的临床资料,对其进行回顾性分析,根据治疗情况分组,A组为予尿激酶20000U/kg静脉滴注2小时,溶栓结束后,开始予以皮下注射低分子肝素治疗,并重叠口服华法林,之后则单纯应用华法林,直至INR达到正常的2-3倍。B组为只用低分子肝素和华法林抗凝。分别治疗2周,对比两组患者的临床症状、体征、呼吸频率、心率、动脉血氧分压(Pa02)、二氧化碳分压(PaCO2)、心肌肌钙蛋白Ⅰ(CTnI)、心脏彩超、螺旋CT肺动脉造影(CTPA)的变化情况及临床疗效,并观察其并发症情况。结果：观察组A组为37例,男性30例,女性7例,年龄为53.1+16.42岁；对照组B组为41例,男性31例,女性10例,年龄为51.8±14.66岁。治疗后两组临床症状、体征均有好转,呼吸频率、心率、肌钙蛋白I均显著降低(尸0.05);PaO2、PaCO2等血气指标治疗后两组均显著改善(P0.05或0.01)；CTPA示治疗总有效率A组显著高于B组(P0.01),心脏彩超示室壁运动改善,肺动脉压力较前降低,A组与B组比较差异有统计学意义(P0.05),A组优于B组。两组临床疗效比较,A组总有效率明显高于B组,两组间比较差异有统计学意义(P0.05)。A组并发出血、血小板减少、肝肾功能损害较B组增多,A、B两组不良反应发生率分别为13.5%、4.88%,但两者比较差异无统计学意义(P0.05)。结论：对于中危组急性PTE的患者,尿激酶溶栓加序贯抗凝治疗优于单纯抗凝治疗,但其不良反应发生率高于单纯抗凝治疗,需提高该方面的警惕性。
[Abstract]:Objective: to investigate the effect of thrombolytic therapy combined with anticoagulant therapy and simple anticoagulant therapy on patients with moderate risk acute pulmonary thromboembolism (Pte) in order to improve the clinical understanding of the disease, improve the level of diagnosis and treatment, and reduce the mortality of the disease. Methods: the clinical data of patients with acute pulmonary embolism diagnosed in the first affiliated Hospital of Guangxi Medical University from January 2010 to December 2012 were collected and analyzed retrospectively. According to the treatment condition, group A was given urokinase 20000Ukg intravenously for 2 hours. After thrombolysis, low molecular weight heparin was injected subcutaneously, warfarin was given orally, then warfarin was used only. Only low molecular weight heparin and warfarin anticoagulant were used in group B until the INR was 2-3 times normal. The clinical symptoms, signs, respiratory frequency, heart rate, arterial partial pressure of oxygen (Pa02), partial pressure of carbon dioxide (PaCO2), cardiac troponin I (CTnI), color echocardiography, spiral CT pulmonary arteriography (CTPA) were compared between the two groups. The complications were observed. Results: there were 37 cases in group A, 30 males and 7 females, aged 53.1 16.42 years, and 41 cases in group B, 31 males and 10 females, aged 51.8 卤14.66 years. After treatment, the clinical symptoms and signs of the two groups were improved, the respiratory rate, heart rate and troponin I were significantly decreased (P < 0.05) and the blood gas indexes such as PaO2 and Paco _ 2 were significantly improved in the two groups (P0.05 or 0.01). CTPA showed that the total effective rate of group A was significantly higher than that of group B (P0.01), cardiac color Doppler echocardiography showed the improvement of ventricular wall motion, pulmonary artery pressure was lower in group A than in group B (P0.05). The total effective rate of group A was significantly higher than that of group B, the difference between the two groups was statistically significant (P0.05) .A group complicated with hemorrhage, thrombocytopenia, The incidence of adverse reactions in group A and B was 13.5and 4.88 respectively, but there was no significant difference between the two groups (P0.05). Conclusion: urokinase thrombolytic therapy plus sequential anticoagulant therapy is superior to anticoagulant therapy alone, but the incidence of adverse reactions is higher than that of anticoagulant therapy alone.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.5

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