CAJ | 학술논문

目的探讨阿替普酶100 mg/2 h溶栓方案治疗急性肺动脉血栓栓塞症的疗效和安全性,并随访观察治疗后肺栓塞复发和慢性血栓栓塞性肺高血压(CTEPH)等并发症的发生情况.方法前瞻性设计观察并记录43例连续入院的中高危急性肺栓塞患者接受100 mg/2 h阿替普酶溶栓治疗前后的临床资料及并发症,并对患者进行门诊及电话随访.平均随访时间为(15.6±11.4)个月.随访研究终点为肺栓塞复发、肺栓塞所致死亡及新发CTEPH.结果与溶栓前比较,溶栓后患者的脉压差增大[(46.7 ±9.3)mm Hg(1 mm Hg=0.133 kPa)比(41.9±11.5) mm Hg,P=0.007],心率[(84.2±14.7)次/min比(93.3±17.7)次/min,P＜0.001]和呼吸频率减慢(P＜0.001);超声心动图可见三尖瓣环收缩期位移显著升高[(18.7 ±3.1)mm比(15.9±3.9)mm,P＜0.001]、右心室横径显著缩小[(34.0 ±3.6)mm比(36.8 ±4.4) mm,P＜0.001];血气分析中氧分压[(87.9±17.8)mm Hg比(73.4±20.1)mm Hg,P＜0.001]、氧饱和度(96.6％±2.4％比92.5％±6.3％,P＜0.001)和肺泡动脉氧分压差[52.1(31.5,76.3)mm Hg比29.9(12.3,55.1)mm Hg,P=0.014]明显改善;D-二聚体明显升高(P ＜0.001),N末端B型利钠肽原明显下降(P ＜0.001).溶栓过程无致死性大出血事件.肺栓塞相关病死率为6.9％ (4/43),无一例新发CTEPH.结论阿替普酶100 mg/2 h溶栓方案可有效改善急性肺血栓栓塞症患者右心功能及预后.
목적 탐토아체보매100 mg/2 h용전방안치료급성폐동맥혈전전새증적료효화안전성,병수방관찰치료후폐전새복발화만성혈전전새성폐고혈압(CTEPH)등병발증적발생정황.방법 전첨성설계관찰병기록43례련속입원적중고위급성폐전새환자접수100 mg/2 h아체보매용전치료전후적림상자료급병발증,병대환자진행문진급전화수방.평균수방시간위(15.6±11.4)개월.수방연구종점위폐전새복발、폐전새소치사망급신발CTEPH.결과 여용전전비교,용전후환자적맥압차증대[(46.7 ±9.3)mm Hg(1 mm Hg=0.133 kPa)비(41.9±11.5) mm Hg,P=0.007],심솔[(84.2±14.7)차/min비(93.3±17.7)차/min,P＜0.001]화호흡빈솔감만(P＜0.001);초성심동도가견삼첨판배수축기위이현저승고[(18.7 ±3.1)mm비(15.9±3.9)mm,P＜0.001]、우심실횡경현저축소[(34.0 ±3.6)mm비(36.8 ±4.4) mm,P＜0.001];혈기분석중양분압[(87.9±17.8)mm Hg비(73.4±20.1)mm Hg,P＜0.001]、양포화도(96.6％±2.4％비92.5％±6.3％,P＜0.001)화폐포동맥양분압차[52.1(31.5,76.3)mm Hg비29.9(12.3,55.1)mm Hg,P=0.014]명현개선;D-이취체명현승고(P ＜0.001),N말단B형리납태원명현하강(P ＜0.001).용전과정무치사성대출혈사건.폐전새상관병사솔위6.9％ (4/43),무일례신발CTEPH.결론 아체보매100 mg/2 h용전방안가유효개선급성폐혈전전새증환자우심공능급예후.
Objective To evaluate the efficacy and safety of 100 mg/2 hours recombinant tissuetype plasminogen activator (rt-PA) regimen for treating patients with acute pulmonary thromboembolism (PE) by observing long-term clinical outcome including recurrent pulmonary embolism,chronic thromboembolic pulmonary hypertension (CTEPH) and other complications.Methods Data of 43 consecutive patients with acute high-risk and intermediate-risk PE treated with intravenous rt-PA (100 mg/2 hours) were prospectively analyzed.Median follow-up post-thrombolysis was (15.6 ± 11.4) months.The endpoints of the study were PE recurrence,death related to PE and onset CTEPH.Results After rt-PA therapy,pulse pressure increased [(46.7 ± 9.5) mm Hg (1 mm Hg =0.133 kPa) vs.(41.9 ± 11.3) mm Hg,P =0.007],heart rate and respiratory rate decreased [(84.2 ± 14.7) bpm vs.(93.3 ± 17.7) bpm,P ＜0.001 ; (20.2 ±2.4) bpm vs.(23.2 ±4.1) bpm,P ＜0.001,respectively],tricuspid annular plane systolic excursion increased [(18.7 ± 3.1) mm vs.(15.9 ± 3.9) mm,P ＜ 0.001] and right ventricle transverse diameter [(34.0 ±3.6) mm vs.(36.8 ±4.4) mm,P ＜0.001].PO2,SO2 and P(A-a)O2 improved [(87.9±17.8) mm Hg vs.(73.4±20.1) mm Hg,P＜0.001;96.6％ ±2.4％ vs.92.5％ ±6.3％,P ＜0.001; 29.9 (12.3,55.1) mm Hg vs.52.1(31.5,76.3) mm Hg,P =0.014,respectively],D-dimer and NT-proBNP levels significant reduced (P ＜ 0.001).Mortality rate related to PE was 6.9％ (4/43) and there was no patient developed CTEPH during follow up.Conclusion The 100 mg/2 hours rt-PA regimen is effective to treat acute PE patients and could improve right heart function and outcome in patients with acute PE.