中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2015年
4期
273-278
,共6页
张颖%朱光发%郭红娟%刘双
張穎%硃光髮%郭紅娟%劉雙
장영%주광발%곽홍연%류쌍
肺血栓栓塞症%溶栓%疗效%不良事件
肺血栓栓塞癥%溶栓%療效%不良事件
폐혈전전새증%용전%료효%불량사건
Pulmonary thromboembolism%Thrombolytic therapy%Efficacy%Adverse events
目的 观察延迟溶栓治疗急性大面积肺血栓栓塞症(PTE)的临床疗效及安全性,探讨影响其疗效的因素.方法 回顾分析2009-2013年北京安贞医院呼吸科收治的病程＞14 d且接受溶栓治疗的急性大面积PTE患者(延迟溶栓组)的临床资料,与同期收治的病程≤14 d且接受溶栓治疗的急性大面积PTE患者(窗内溶栓组)进行比较,观察2组治疗前基本情况、基础疾病,治疗后1周的有效率和出血发生率,分析影响延迟溶栓治疗疗效的因素.共纳入患者62例,均经CTPA确诊,其中男28例,女34例,平均年龄(55.6±1.9)岁,窗内溶栓组32例,延迟溶栓组30例.结果 与窗内溶栓组[(7.2±0.6)d]比较,延迟溶栓组病程较长[(24.8±0.9)d,P ＜0.001],症状加重时间为(5.3±0.8)d,与窗内溶栓组[(55±4)mmHg,1 mmHg =0.133 kPa]比较,延迟溶栓组超声心动图肺动脉收缩压(SPAP)较高[(69 ±4) mmHg,P=0.016],两组年龄、性别、D-二聚体、CT肺动脉阻塞指数(CTI)、血B型脑钠肽(BNP)、心肌肌钙蛋白I(TNI)、PaCO2和PaO2检测结果差异均无统计学意义.治疗后1周有效率和出血发生率延迟溶栓组分别为77％和30％,窗内溶栓组分别为78％和25％,两组比较差异无统计学意义(P＞0.05).单因素分析显示延迟溶栓治疗有效组合并高血压病比例较高,年龄较大,PaO2较低(P＜0.05或＜0.01),logistic多因素回归分析未发现延迟溶栓治疗有效的预测因素(均P ＞0.05).结论 对于病程＞14d、新近症状加重且D-二聚体增高的急性大面积PTE(高危层),采取延迟溶栓治疗,其疗效和安全性与窗内溶栓治疗相当.影响延迟溶栓患者疗效的危险因素尚待进一步明确.
目的 觀察延遲溶栓治療急性大麵積肺血栓栓塞癥(PTE)的臨床療效及安全性,探討影響其療效的因素.方法 迴顧分析2009-2013年北京安貞醫院呼吸科收治的病程＞14 d且接受溶栓治療的急性大麵積PTE患者(延遲溶栓組)的臨床資料,與同期收治的病程≤14 d且接受溶栓治療的急性大麵積PTE患者(窗內溶栓組)進行比較,觀察2組治療前基本情況、基礎疾病,治療後1週的有效率和齣血髮生率,分析影響延遲溶栓治療療效的因素.共納入患者62例,均經CTPA確診,其中男28例,女34例,平均年齡(55.6±1.9)歲,窗內溶栓組32例,延遲溶栓組30例.結果 與窗內溶栓組[(7.2±0.6)d]比較,延遲溶栓組病程較長[(24.8±0.9)d,P ＜0.001],癥狀加重時間為(5.3±0.8)d,與窗內溶栓組[(55±4)mmHg,1 mmHg =0.133 kPa]比較,延遲溶栓組超聲心動圖肺動脈收縮壓(SPAP)較高[(69 ±4) mmHg,P=0.016],兩組年齡、性彆、D-二聚體、CT肺動脈阻塞指數(CTI)、血B型腦鈉肽(BNP)、心肌肌鈣蛋白I(TNI)、PaCO2和PaO2檢測結果差異均無統計學意義.治療後1週有效率和齣血髮生率延遲溶栓組分彆為77％和30％,窗內溶栓組分彆為78％和25％,兩組比較差異無統計學意義(P＞0.05).單因素分析顯示延遲溶栓治療有效組閤併高血壓病比例較高,年齡較大,PaO2較低(P＜0.05或＜0.01),logistic多因素迴歸分析未髮現延遲溶栓治療有效的預測因素(均P ＞0.05).結論 對于病程＞14d、新近癥狀加重且D-二聚體增高的急性大麵積PTE(高危層),採取延遲溶栓治療,其療效和安全性與窗內溶栓治療相噹.影響延遲溶栓患者療效的危險因素尚待進一步明確.
목적 관찰연지용전치료급성대면적폐혈전전새증(PTE)적림상료효급안전성,탐토영향기료효적인소.방법 회고분석2009-2013년북경안정의원호흡과수치적병정＞14 d차접수용전치료적급성대면적PTE환자(연지용전조)적림상자료,여동기수치적병정≤14 d차접수용전치료적급성대면적PTE환자(창내용전조)진행비교,관찰2조치료전기본정황、기출질병,치료후1주적유효솔화출혈발생솔,분석영향연지용전치료료효적인소.공납입환자62례,균경CTPA학진,기중남28례,녀34례,평균년령(55.6±1.9)세,창내용전조32례,연지용전조30례.결과 여창내용전조[(7.2±0.6)d]비교,연지용전조병정교장[(24.8±0.9)d,P ＜0.001],증상가중시간위(5.3±0.8)d,여창내용전조[(55±4)mmHg,1 mmHg =0.133 kPa]비교,연지용전조초성심동도폐동맥수축압(SPAP)교고[(69 ±4) mmHg,P=0.016],량조년령、성별、D-이취체、CT폐동맥조새지수(CTI)、혈B형뇌납태(BNP)、심기기개단백I(TNI)、PaCO2화PaO2검측결과차이균무통계학의의.치료후1주유효솔화출혈발생솔연지용전조분별위77％화30％,창내용전조분별위78％화25％,량조비교차이무통계학의의(P＞0.05).단인소분석현시연지용전치료유효조합병고혈압병비례교고,년령교대,PaO2교저(P＜0.05혹＜0.01),logistic다인소회귀분석미발현연지용전치료유효적예측인소(균P ＞0.05).결론 대우병정＞14d、신근증상가중차D-이취체증고적급성대면적PTE(고위층),채취연지용전치료,기료효화안전성여창내용전치료상당.영향연지용전환자료효적위험인소상대진일보명학.
Objective To observe the efficacy and safety of delayed thrombolytic therapy on acute massive pulmonary thromboembolism (PTE) and discuss the influence factors.Methods From 2009 to 2013,the clinical data of patients with acute massive pulmonary thromboembolism were analyzed retrospectively.Patients with over 14-day duration and treated with thrombolytic therapy (delayed thrombolytic group) were compared with those within 14-day duration and treated with thrombolytic therapy (normal thrombolytic group) in the same period.General conditions before treatment,case history,efficacy and the incidence of bleeding after one-week treatment were collected.The influence factors of delayed thrombolytic therapy were analyzed.Results Sixty two cases were collected and divided into the normal thrombolytic group with 32 cases and the delayed thrombolytic group with 30 cases.Compared with the normal thrombolytic group,the delayed thrombolytic group had a longer duration [(24.8 ± 0.9) vs.(7.2 ±0.6)d,P ＜0.001],an aggravation time of (5.3 ±0.8) d,and higher systolic pulmonary arterial pressure (SPAP) [(69 ±4)vs.(55 ±4)mmHg,1 mmHg=0.133 kPa,P=0.016].Ages,genders,D-Dimmer,CT subpulmonic obstruction index (CTI),brain natriuretic peptide (BNP),cardiactroponinI (TnI),PaCO2 values and PaO2 values had no statistical difference between two groups.After one-week treatment,the efficacy and the incidence of bleeding was 78％ and 25％ respectively in normal thrombolytic group,while they were 77％ and 30％ respectively in delayed thrombolytic group,and there was no significantdifference between two groups (P ＞ 0.05).The single factor analysis showed that the delayed thrombolytic group had more patients with hypertension,were older and had a lower PaO2 (P ＜ 0.05 or 0.01).Multivariate logistic regression analysis did not find the predictors of delayed thrombolytic therapy (P ＞ 0.05).Conclusions For acute massive PTE patients with duration over 14 days,increased D-D and new exacerbation of symptoms,delayed thrombolytic therapy had the same efficacy with the normal thrombolytic therapy.The factors for predicting efficacy need further research.
