摘要
背景目前关于急性中高危肺血栓栓塞症(PTE)患者的溶栓和抗凝治疗策略仍在不断探索和完善。重组人尿激酶原(rhPro-UK)因安全性高、出血风险低等优势而被广泛应用于急性心肌梗死静脉溶栓治疗,但其用于急性PTE患者溶栓治疗的相关报道较少。目的探讨rhPro-UK联合肝素治疗急性中高危PTE患者的有效性及安全性。方法选取2018—2020年秦皇岛市第二医院治疗的急性中高危PTE患者60例,按照随机数字表法分为对照组30例和观察组30例。患者入院后均给予肝素治疗,其中对照组持续泵注肝素治疗,观察组给予注射用重组人尿激酶原治疗。比较两组患者治疗前及治疗后24 h血气分析〔包括动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))〕、血清D-二聚体水平、血清N末端脑钠肽前体(NT-proBNP)水平、右房室瓣环收缩期位移(TAPSE)、肺动脉压,并比较两组患者治疗后24 h呼吸困难改善情况及治疗1周后不良事件发生情况(包括血流动力学失代偿、死亡、出血)。结果两组患者治疗前PaO_(2)、PaCO_(2)及血清D-二聚体、NT-proBNP水平比较,差异无统计学意义(P>0.05);观察组患者治疗后24 h PaO_(2)、PaCO_(2)、血清D-二聚体水平及呼吸困难改善率高于对照组,血清NT-proBNP水平分别低于对照组(P<0.05)。两组患者治疗后24 h PaO_(2)、PaCO_(2)及血清D-二聚体水平分别高于本组治疗前,血清NT-proBNP水平分别低于本组治疗前(P<0.05)。两组患者治疗前TAPSE、肺动脉压比较,差异无统计学意义(P>0.05);观察组患者治疗后24 h TAPSE大于对照组,肺动脉压低于对照组(P<0.05)。两组患者治疗后24 h TAPSE分别大于本组治疗前,肺动脉压分别低于本组治疗前(P<0.05)。治疗1周后,两组均未发生死亡及重度出血,其中观察组患者血流动力学失代偿发生率低于对照组,不明显出血发生率高于对照组(P<0.05)。结论rhPro-UK联合肝素可有效地缓解急性中高危PTE患者的低氧血症、呼吸困难症状,改善右心功能,稳定血流动力学,降低肺动脉压,短期疗效确切。
Background Thrombolytic and anticoagulant therapeutic strategies of acute intermediate-high-risk pulmonary thromboembolism(PTE)are also constantly exploring and improving.Recombinant human prourokinase(rhPro-UK)has been widely used in the treatment of acute myocardial infarction due to its high safety and low risk of bleeding.However,there are few reports about its application in the treatment of PTE.Objective To discuss the efficacy and safety of rhPro-UK plus heparin in the treatment of acute intermediate-high-risk PTE.Methods A total of 60 cases of patients with acute intermediate-high-risk PTE were selected in the Second Hospital of Qinhuangdao from 2018 to 2020,and they were divided into the control group and the observation group according to random number table method,each of 30 cases.All patients were treated with heparin,patients in the control group were received continuous pumping injection with heparin,while patients inthe observation group were received with rhPro-UK.Blood-gas analysis〔including arterial partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2))〕,serum levels of D-dimer,N-terminal pro-brain natriuretic peptide(NT-proBNP),tricuspid annulus plane systolic excursion(TAPSE),pulmonary artery pressure before treatment and 24 h after treatment,incidence of dyspnea improvement 24 h after treatment,adverse events(including hemodynamic decompensation,death,bleeding) at 1 week after treatment were compared between the two groups.Results No statistically significant difference ofPaO_(2),PaCO_(2),serum levels of D-dimer,NT-proBNP between the two groups before treatment(P > 0.05);at 24 h aftertreatment,PaO_(2),PaCO_(2),serum D-dimer level and dyspnea improvement rate in the observation group were higher than thosein the control group,serum NT-proBNP level was lower than that in the control group(P < 0.05).PaO_(2),PaCO_(2),serum D-dimerlevel at 24 h after treatment were higher than those before treatment,serum NT-proBNP level was lower than that beforetreatment in the two groups(P < 0.05).There was no significant difference of TAPSE,pulmonary artery pressure betweenthe two groups before treatment(P > 0.05);at 24 h after treatment,TAPSE in the observation group was larger than that inthe control group,pulmonary artery pressure was lower than that in the control group(P < 0.05).At 24 h after treatment,TAPSE was larger than that before treatment,pulmonary artery pressure was lower than that before treatment in the two groups(P < 0.05).1 week after treatment,no death or serious bleeding cases happened,and incidence of hemodynamicdecompensation in the observation group was lower than that in the control group,incidence of inconspicuous bleeding in theobservation group was higher than that in the control group(P < 0.05).Conclusion For patients with acute intermediatehigh-risk PTE,rhPro-UK plus heparin can effectively relieve hyoxemia,respiratory related symptoms,and improve rightventricular function,keep hemodynamics stable,and reduce the pulmonary artery pressure,the short-term effect is definite.
作者
肖立平
田洋
曾盼
崔金医
冯春晖
李天予
孙艳辉
XIAO Liping;TIAN Yang;ZENG Pan;CUI Jinyi;FENG Chunhui;LI Tianyu;SUN Yanhui(Department of Cardiology,the Second Hospital of Qinhuangdao,Qinhuangdao 066600,China)
出处
《实用心脑肺血管病杂志》
2021年第5期80-84,共5页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
秦皇岛市市级科技计划自筹经费项目(201902A078)。
关键词
肺血栓栓塞症
重组人尿激酶原
肝素
有效性
安全性
Pulmonary thromboembolism
Recombinant human prourokinase
Heparin
Efficiency
Safety
