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目的:探讨溶栓与单纯抗凝治疗急性次大面积肺栓塞患者的疗效与安全性。方法:63例急性次大面积肺血栓栓塞症患者,被随机分为溶栓组(n=32)与单纯抗凝组(n=31)。观察两组治疗前与治疗2周后动脉血气指标及右心功能指标变化,进行疗效分析。统计两组出血、血小板减少发生情况。结果:治疗后两组动脉血气指标及右心功能指标较治疗前显著改善(P<0.05或<0.01);与单纯抗凝组比较,溶栓组动脉血氧分压[PaO2,(77.8±7.3)mmHg比(83.4±8.7)mmHg]、右室前壁活动度[RVAWM,(4.9±1.7)mm比(5.8±2.2)mm]显著上升,肺泡-动脉血氧分压差[P(A-a)O2,(23.1±2.8)mmHg比(16.5±2.4)mmHg]、肺动脉收缩压[PASP,(54.6±7.9)mmHg比(34.2±7.5)mmHg]显著下降(P<0.05或<0.01)。溶栓组总有效率显著高于单纯抗凝组(100%比80.6%,P=0.002)。两组出血发生率及血小板减少发生率无统计学差异(P>0.05)。结论:溶栓治疗可显著降低急性次大面积肺栓塞患者的肺动脉压力,改善氧合及右室功能指标,无禁忌患者可考虑优先推荐。
Objective: To investigate the efficacy and safety of thrombolytic therapy and simple anticoagulation therapy in patients with acute sub-large pulmonary embolism. Methods: Sixty-three patients with acute sub-maximal pulmonary thromboembolism were randomly divided into thrombolysis group (n = 32) and anticoagulation group (n = 31). The changes of arterial blood gas index and right heart function were observed before treatment and two weeks after treatment, and the curative effect was analyzed. Statistics of two groups of bleeding, thrombocytopenia occurred. Results: After treatment, arterial blood gas index and right heart function index were significantly improved in both groups (P <0.05 or <0.01). Compared with the simple anticoagulation group, arterial partial pressure of oxygen in the thrombolytic group [PaO2, (77.8 ± 7.3 (83.4 ± 8.7) mmHg], RVAWM (4.9 ± 1.7) mm (5.8 ± 2.2) mm], and the difference in alveolar-arterial oxygen pressure [P O2, (23.1 ± 2.8) mmHg (16.5 ± 2.4) mmHg] and pulmonary artery systolic pressure (PASP, (54.6 ± 7.9) mmHg vs 34.2 ± 7.5 mmHg] were significantly decreased (P <0.05 or <0.01). The total effective rate of thrombolysis group was significantly higher than the simple anticoagulation group (100% vs 80.6%, P = 0.002). There was no significant difference in the incidence of hemorrhage and thrombocytopenia between the two groups (P> 0.05). Conclusion: Thrombolytic therapy can significantly reduce pulmonary arterial pressure in patients with acute sub-large pulmonary embolism and improve oxygenation and right ventricular function. Patients without contraindication may be considered as the first recommendation.