心血管康复医学杂志
心血管康複醫學雜誌
심혈관강복의학잡지
JOURNAL OF CARDIOVASCULAR REHABILITATION MEDICINE
2014年
3期
279-283
,共5页
肺栓塞%心室功能障碍,右%血栓溶解疗法%抗凝药
肺栓塞%心室功能障礙,右%血栓溶解療法%抗凝藥
폐전새%심실공능장애,우%혈전용해요법%항응약
Pulmonary embolism%Ventricular dysfunction,right%Thrombolytic therapy%Anticoagulants
目的：探讨溶栓与单纯抗凝治疗急性次大面积肺栓塞患者的疗效与安全性。方法：63例急性次大面积肺血栓栓塞症患者，被随机分为溶栓组（n＝32）与单纯抗凝组（n＝31）。观察两组治疗前与治疗2周后动脉血气指标及右心功能指标变化，进行疗效分析。统计两组出血、血小板减少发生情况。结果：治疗后两组动脉血气指标及右心功能指标较治疗前显著改善（P＜0.05或＜0.01）；与单纯抗凝组比较，溶栓组动脉血氧分压[PaO2，（77.8±7.3）mmHg比（83.4±8.7）mmHg]、右室前壁活动度[RVAWM，（4.9±1.7）mm比（5.8±2.2）mm]显著上升，肺泡-动脉血氧分压差[P （A-a）O2，（23.1±2.8）mmHg比（16.5±2.4）mmHg]、肺动脉收缩压[PASP，（54.6±7.9）mmHg比（34.2±7.5）mmHg]显著下降（P＜0.05或＜0.01）。溶栓组总有效率显著高于单纯抗凝组（100％比80.6％，P＝0.002）。两组出血发生率及血小板减少发生率无统计学差异（P＞0.05）。结论：溶栓治疗可显著降低急性次大面积肺栓塞患者的肺动脉压力，改善氧合及右室功能指标，无禁忌患者可考虑优先推荐。
目的：探討溶栓與單純抗凝治療急性次大麵積肺栓塞患者的療效與安全性。方法：63例急性次大麵積肺血栓栓塞癥患者，被隨機分為溶栓組（n＝32）與單純抗凝組（n＝31）。觀察兩組治療前與治療2週後動脈血氣指標及右心功能指標變化，進行療效分析。統計兩組齣血、血小闆減少髮生情況。結果：治療後兩組動脈血氣指標及右心功能指標較治療前顯著改善（P＜0.05或＜0.01）；與單純抗凝組比較，溶栓組動脈血氧分壓[PaO2，（77.8±7.3）mmHg比（83.4±8.7）mmHg]、右室前壁活動度[RVAWM，（4.9±1.7）mm比（5.8±2.2）mm]顯著上升，肺泡-動脈血氧分壓差[P （A-a）O2，（23.1±2.8）mmHg比（16.5±2.4）mmHg]、肺動脈收縮壓[PASP，（54.6±7.9）mmHg比（34.2±7.5）mmHg]顯著下降（P＜0.05或＜0.01）。溶栓組總有效率顯著高于單純抗凝組（100％比80.6％，P＝0.002）。兩組齣血髮生率及血小闆減少髮生率無統計學差異（P＞0.05）。結論：溶栓治療可顯著降低急性次大麵積肺栓塞患者的肺動脈壓力，改善氧閤及右室功能指標，無禁忌患者可攷慮優先推薦。
목적：탐토용전여단순항응치료급성차대면적폐전새환자적료효여안전성。방법：63례급성차대면적폐혈전전새증환자，피수궤분위용전조（n＝32）여단순항응조（n＝31）。관찰량조치료전여치료2주후동맥혈기지표급우심공능지표변화，진행료효분석。통계량조출혈、혈소판감소발생정황。결과：치료후량조동맥혈기지표급우심공능지표교치료전현저개선（P＜0.05혹＜0.01）；여단순항응조비교，용전조동맥혈양분압[PaO2，（77.8±7.3）mmHg비（83.4±8.7）mmHg]、우실전벽활동도[RVAWM，（4.9±1.7）mm비（5.8±2.2）mm]현저상승，폐포-동맥혈양분압차[P （A-a）O2，（23.1±2.8）mmHg비（16.5±2.4）mmHg]、폐동맥수축압[PASP，（54.6±7.9）mmHg비（34.2±7.5）mmHg]현저하강（P＜0.05혹＜0.01）。용전조총유효솔현저고우단순항응조（100％비80.6％，P＝0.002）。량조출혈발생솔급혈소판감소발생솔무통계학차이（P＞0.05）。결론：용전치료가현저강저급성차대면적폐전새환자적폐동맥압력，개선양합급우실공능지표，무금기환자가고필우선추천。
Objective:To explore the therapeutic effect and safety of thrombolysis and pure anticoagulation therapy in patients with acute submassive pulmonary embolism.Methods:A total of 6 3 patients with acute submassive pul-monary embolism were randomly divided into thrombolysis group (n=32)and pure anticoagulation group (n=31). Arterial blood gas index and right heart functional index changes of two groups were observed before treatment and after two-week treatment,and their therapeutic effects were compared and analyzed.Incidence of bleeding and thrombocytopenia were counted in two groups.Results:Compared with before treatment,there were significant improvements in arterial blood gas and right heart functional indexes after treatment in two groups,P<0.05 or <0.0 1;compared with pure anticoagulation group,there were significant rise in partial pressure of oxygen in artery [PaO2 , (77.8±7.3)mmHg vs.(83.4±8.7)mmHg],right ventricular anterior wall motion [RVAWM,(4.9± 1.7)mm vs.(5.8±2.2)mm];and significant descent in alveolar-arterial oxygen difference [P (A-a)O2 ,(23.1± 2.8)mmHg vs.(16.5±2.4)mmHg mmHg],pulmonary artery systolic pressure [PASP,(54.6±7.9)mmHg vs. (34.2 ± 7.5 )mmHg] in thrombolysis group,P<0.05 or <0.01. Total effective rate of thrombolysis group (100%)was significantly higher than that of pure anticoagulation group (80.6%),P=0.002. There were no signif-icant difference in incidence rates of bleeding and thrombocytopenia between two groups,P>0.05. Conclusion:Thrombolysis therapy can significantly lower pulmonary artery pressure and improve oxygenation and right ventricu-lar function indexes in patients with acute submassive pulmonary embolism.It may be a preferred recommendation for patients without contraindications.
