摘要
目的观察阿替普酶联合低分子肝素治疗急性肺血栓栓塞症的临床效果及安全性。方法回顾性分析2012年1月～2015年8月我院重症医学科收治的54例急性PTE患者，45例应用阿替普酶联合低分子肝素治疗．9例应用尿激酶联合低分子肝素治疗，观察两组疗效及并发症。结果观察组有效42例，无效3例。其中2例并发脑出血死亡，对照组有效6例，无效3例，其中1例并发脑出血死亡，两组治疗效果有显著性差异（P〈0．05）：但脑出血的发生率无显著性差异（P〉0．05）。溶栓效果与发生肺栓塞的时间有关，时间越短，溶栓效果越好（P〈0．05）。结论阿替普酶联合低分子肝素治疗急性PTE效果肯定，但同尿激酶一样可出现出血的并发症．尤其是脑出血。如果溶栓后出现头痛，且逐渐出现神志改变，有可能发生脑出血，要注意观察，一旦发生预后不良。
Objective To observe the clinical effect and safety of aheplase combined with low molecular weight heparin （LMWH） in treatment of acute pulmonary thromboembolism （APTE）. Methods A total of 54 patients with APTE treated in the ICU of our hospital from January 2012 to August 2015 were reviewed. Among these patients, 45 were treated by alteplase combined with LMWH, and 9 were treated by urokinase combined with LMWH. The clinical effects and complications of both groups were observed. Results In the observaton group, 42 cases re- sponded, while 3 cases showed no response, of which 2 patients died from complicated cerebral hemorrhage. In the control group, 6 cases responded and 3 cases showed no response, of which 1 patient died from complicated cerebral hemorrhage. The therapeutic effects were significantly different between the two groups（P〈0.05）. However, the incidence rates of cerebral hemorrhage showed no difference（P〉0.05）. The effect of thrombolysis was related to the time of PTE. A shorter time of PTE indicated better thrombolysis effects, which was statistically significant （P〈0.05）. Conclusion The effect of aheplase combined with LMWH is favorable in treatment of APTE. However, this therapy has similar risk in hemorrhagic complications with urokinase, especially cerebral hemorrhage. Headache after thrombolysis with progressive change of consciousness may indicate cerebral hemorrhage, which should be closely observed due to its unfavorable prognosis.
出处
《中国现代医生》
2016年第4期102-104,共3页
China Modern Doctor
关键词
阿替普酶
低分子肝素
急性肺血栓栓塞症
脑出血
Aheplase
Low molecular heparin
Acute pulmonary thromboembolism
Cerebral hemorrhage
