CAJ | 학술논문

目的通过前瞻性非随机的对照研究,探讨中危组急性肺栓塞患者接受溶栓治疗的安全性及有效性.方法连续选择首都医科大学附属北京安贞医院急诊重症监护室2005年6月至2012年5月期间明确诊断的中危组急性肺栓塞177例,其中接受溶栓治疗患者102例,抗凝治疗75例,分别对其在接受治疗后2h、24 h、7d的临床症状、客观指标、肺动脉增强CT及肺灌注通气结果进行评价,数据处理采用配对t检验和x2检验进行统计学分析.结果 ①两组患者基础病比较差异无统计学意义(P＞0.05),溶栓组出血6例(5.9％),抗凝组1例(1.3％) (P＜0.05),均无致命性出血病例发生；②溶栓组患者治疗2h呼吸、心率、血压的变化差异具有统计学意义(P＜0.01)；治疗24 h肺动脉收缩压及三尖瓣返流速度明显改善(P＜0.01)；与溶栓组相比,差异具有统计学意义(P＜0.01)；③溶栓治疗7d后双下肢深静脉超声显示显效率、好转率分别为83％和96.2％；肺血管增强CT及肺灌注/通气显示显效率、好转率分别为66.7％和98％,明显优于抗凝组(P＜0.01)；④亚组分析结果显示:发病3d内患者溶栓治疗后的显效率明显高于病程3d以上者(P＜0.01).结论 ①中危肺栓塞患者接受溶栓治疗是安全的,强调除外新发不典型脑血管意外事件；②溶栓治疗在2h内迅速缓解中危肺栓塞患者的急性症状；③治疗7d血栓负荷变化提示溶栓组显效率优于抗凝组；④溶栓治疗效果取决于病程.
목적 통과전첨성비수궤적대조연구,탐토중위조급성폐전새환자접수용전치료적안전성급유효성.방법 련속선택수도의과대학부속북경안정의원급진중증감호실2005년6월지2012년5월기간명학진단적중위조급성폐전새177례,기중접수용전치료환자102례,항응치료75례,분별대기재접수치료후2h、24 h、7d적림상증상、객관지표、폐동맥증강CT급폐관주통기결과진행평개,수거처리채용배대t검험화x2검험진행통계학분석.결과 ①량조환자기출병비교차이무통계학의의(P＞0.05),용전조출혈6례(5.9％),항응조1례(1.3％) (P＜0.05),균무치명성출혈병례발생；②용전조환자치료2h호흡、심솔、혈압적변화차이구유통계학의의(P＜0.01)；치료24 h폐동맥수축압급삼첨판반류속도명현개선(P＜0.01)；여용전조상비,차이구유통계학의의(P＜0.01)；③용전치료7d후쌍하지심정맥초성현시현효솔、호전솔분별위83％화96.2％；폐혈관증강CT급폐관주/통기현시현효솔、호전솔분별위66.7％화98％,명현우우항응조(P＜0.01)；④아조분석결과현시:발병3d내환자용전치료후적현효솔명현고우병정3d이상자(P＜0.01).결론 ①중위폐전새환자접수용전치료시안전적,강조제외신발불전형뇌혈관의외사건；②용전치료재2h내신속완해중위폐전새환자적급성증상；③치료7d혈전부하변화제시용전조현효솔우우항응조；④용전치료효과취결우병정.
Objective To study prospectively the safety and efficacy of the thromblytic therapy in acute submassive pulmonary thromboembolism (PTE) without randomized control.Methods A total of consecutive 177 patients with acute submassive PTE admitted to the emergency intensive care unit were screened from June of 2005 to May of 2012.After a comprehensive screening,102 patients were treated with thrombolytic therapy (TT group),and 75 with anticoagulation therapy (AT group).Clinical signs and physical examination findings were recorded 2 hours,24 hours and 7 days after treatment.Echocardiography (ECG) was repeated 24 hours later.Lung perfusion scan and CT pulmonary artery (CTPA) were repeated on the 7th day.All data was analyzed by paired t test and Chi-square test.Results ①Bleeding happened in 6 patients of TT group and in 1 patient of AT group (P ＞ 0.05),and no lethal hemorrhage occurred in the two groups.There were no statistically significant differences in demographics and clinical history of patients between TT group and AT group (P ＞ 0.05).②There were statistically significant changes in respiratory rate,heart rate and systolic blood pressure in the TT group 2 hours after treatment and great changes in systolic pressure of pulmonary artery (SPAP) and tricuspid regurgitation at 24 hours after treatment (P ＜0.01),whereas obvious change in respiratory rate in AT group was found 24 hours after treatment.③In the TT group 7 days after treatment,significant efficiency rate and total improvement of the deep vein thrombosis (DVT) identified by ultrasonography were 83.0％ and 96.2％ respectively,and those of CTPA and lung perfusion scan were 66.7％ and 98％ respectively.The efficiency of TT was significantly superior over AT in this respect (P ＜ 0.01).④The efficiency of TT given within 3 days after onset of PTE was significantly higher than that of TT conferred over 3 days after onset of PTE (P ＜ 0.01).Conclusions ①Thrombolytic therapy is safe and effective for the submassive PTE,but atypical cerebrovascular accident must be rule out first.②Thrombolytic therapy can improve the symptom of the patient in 2 hours compare with AT.③ Thrombus burden can be reduced more obviously in TT group after 7 days treatment compare with the AT group.④The effect of thrombolytic therapy depends on the time as ti given during the course of disease,the earlier administration the better efficacy.