中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2013年
7期
734-737
,共4页
费建文%唐燕%姜俊杰%康丽君%戴红
費建文%唐燕%薑俊傑%康麗君%戴紅
비건문%당연%강준걸%강려군%대홍
创伤和损伤%肺栓塞%抗凝药%血栓溶解疗法
創傷和損傷%肺栓塞%抗凝藥%血栓溶解療法
창상화손상%폐전새%항응약%혈전용해요법
Wounds and injuries%Pulmonary embolism%Anticoagulats%Thrombolytic
目的 比较溶栓和抗凝治疗在中老年人急性次大面积肺栓塞的有效性和安全性. 方法 选取我院创伤骨科住院的急性次大面积肺栓塞患者45例,根据患者病情且在其知情同意的情况下分为溶栓组22例和抗凝组23例.在溶栓和(或)抗凝治疗前、后进行症状体征、血气分析、D-二聚体、心脏超声、CT血管造影的监测. 结果 溶栓组临床总有效率为95.5％(21/22),抗凝组临床总有效率为91.3％(21/23),均无死亡患者,两组间比较差异无统计学意义(x2=0.32,P＞0.05).溶栓组出血率27.3％(6例),抗凝组出血率4.3％(1例),两组间差异有统计学意义(x2=4.53,P＜0.05).溶栓和(或)抗凝治疗24 h后,溶栓组呼吸困难改善率45.5％(10/22)、动脉血氧分压水平(80.4±8.1)mm Hg(1 mm Hg=0.133 kPa),较抗凝组17.4％ (4/23)、(73.6±9.3)mm Hg升高(x2=2.04,t=2.61,均P＜0.05),肺动脉压水平(51.2±6.2)mm Hg较抗凝组(60.3±5.7)mm Hg降低,差异有统计学意义(均P＜0.05).其他各时间点比较,两组差异无统计学意义. 结论 溶栓可迅速改善症状、降低肺动脉压,建议出血可能性小、病情较重的患者可采用溶栓治疗；而出血可能性大、病情较轻的患者可采用抗凝治疗.
目的 比較溶栓和抗凝治療在中老年人急性次大麵積肺栓塞的有效性和安全性. 方法 選取我院創傷骨科住院的急性次大麵積肺栓塞患者45例,根據患者病情且在其知情同意的情況下分為溶栓組22例和抗凝組23例.在溶栓和(或)抗凝治療前、後進行癥狀體徵、血氣分析、D-二聚體、心髒超聲、CT血管造影的鑑測. 結果 溶栓組臨床總有效率為95.5％(21/22),抗凝組臨床總有效率為91.3％(21/23),均無死亡患者,兩組間比較差異無統計學意義(x2=0.32,P＞0.05).溶栓組齣血率27.3％(6例),抗凝組齣血率4.3％(1例),兩組間差異有統計學意義(x2=4.53,P＜0.05).溶栓和(或)抗凝治療24 h後,溶栓組呼吸睏難改善率45.5％(10/22)、動脈血氧分壓水平(80.4±8.1)mm Hg(1 mm Hg=0.133 kPa),較抗凝組17.4％ (4/23)、(73.6±9.3)mm Hg升高(x2=2.04,t=2.61,均P＜0.05),肺動脈壓水平(51.2±6.2)mm Hg較抗凝組(60.3±5.7)mm Hg降低,差異有統計學意義(均P＜0.05).其他各時間點比較,兩組差異無統計學意義. 結論 溶栓可迅速改善癥狀、降低肺動脈壓,建議齣血可能性小、病情較重的患者可採用溶栓治療；而齣血可能性大、病情較輕的患者可採用抗凝治療.
목적 비교용전화항응치료재중노년인급성차대면적폐전새적유효성화안전성. 방법 선취아원창상골과주원적급성차대면적폐전새환자45례,근거환자병정차재기지정동의적정황하분위용전조22례화항응조23례.재용전화(혹)항응치료전、후진행증상체정、혈기분석、D-이취체、심장초성、CT혈관조영적감측. 결과 용전조림상총유효솔위95.5％(21/22),항응조림상총유효솔위91.3％(21/23),균무사망환자,량조간비교차이무통계학의의(x2=0.32,P＞0.05).용전조출혈솔27.3％(6례),항응조출혈솔4.3％(1례),량조간차이유통계학의의(x2=4.53,P＜0.05).용전화(혹)항응치료24 h후,용전조호흡곤난개선솔45.5％(10/22)、동맥혈양분압수평(80.4±8.1)mm Hg(1 mm Hg=0.133 kPa),교항응조17.4％ (4/23)、(73.6±9.3)mm Hg승고(x2=2.04,t=2.61,균P＜0.05),폐동맥압수평(51.2±6.2)mm Hg교항응조(60.3±5.7)mm Hg강저,차이유통계학의의(균P＜0.05).기타각시간점비교,량조차이무통계학의의. 결론 용전가신속개선증상、강저폐동맥압,건의출혈가능성소、병정교중적환자가채용용전치료；이출혈가능성대、병정교경적환자가채용항응치료.
Objective To compare the efficacy and safety of thrombolysis and anticoagulant therapy for post-traumatic acute submassive pulmonary embolism (PE) in middle-aged and elderly patients.Methods Totally 45 patients with post-traumatic acute submassive pulmonary embolism in our hospital were selected.Patients were divided into thrombolysis group (n =22) and anticoagulation group (n=23) according to their conditions.Symptoms and signs,blood gas analysis,D-dimer,echocardiography,CT pulmonary angiography (CTPA) were performed before and after thrombolysis or anticoagulant therapy.Results There were no significant differences in clinical curative rate between thrombolysis group and anticoagulation group [95.5％ (21/22) vs.91.3％ (21/23),x2 =0.32,P＞0.05],and no case was found dead in both two groups.There was a significant difference in hemorrhage rate between thrombolysis group and anticoagulation group [27.3％ vs.4.3％,x2 =4.53,P ＜ 0.05].At 24 hours after thrombolysis or anticoagulant therapy,the improvement rate of dyspnea,PaO2 level was significantly higher and the pulmonary arterial pressure was significantly lower in thrombolysis group than in anticoagulation group [45.5％ (10/22) vs.17.4％ (4/23),(80.4±8.1) mm Hg vs.(73.6±9.3) mm Hg,(51.2±6.2) mm Hgvs.(60.3±5.7) mm Hg,respectively,all P＜0.05],and there were no statistical significances at other time points between the two groups.Conclusions The clinical curative rate and fatality rate are similar in thrombolysis group versus anticoagulation group.Hemorrhage rate is higher in thrombolysis group than in anticoagulation group.Thrombolysis can relieve dyspnea rapidly,reduce pulmonary artery pressure and make the embolized blood vessels recanalized.Patients with low bleeding risk in a critical condition are suggested to take thrombolysis therapy,while patients with high bleeding risk in a light condition are suggested to take anticoagulant therapy.
