摘要
目的探讨瑞替普酶(r-PA)三种不同给药方式对早期大面积急性肺血栓栓塞症(APTE)溶栓疗效的影响。方法 2013年1月-2016年12月,选取我院符合溶栓指征的APTE患者90例,按照数字表法随机分为3组,分别采用不同的溶栓方案:(1)A组:r-PA18 mg溶于50 m L生理盐水静脉泵入2 h;(2)B组:rPA18 mg溶于10 m L的生理盐水,单次静脉推注>2 min;(3)C组:r-PA18 mg溶于10 m L的生理盐水,两次静脉推注,每次时间>2 min,两次间隔时间为30 min。观察比较溶栓前及溶栓后24 h右心室内径、肺动脉收缩压、动脉血氧分压的变化,评价溶栓疗效,观察溶栓后3 d内出血并发症。结果 (1)溶栓24 h后,三组患者的右心室内径、肺动脉收缩压、动脉血氧分压均较治疗前显著改善(均P<0.01)。三组患者溶栓24 h后的多重比较:(1)右心室内径:A与B比较差异无统计学意义(P>0.05),C与A、C与B比较差异均有统计学意义(均P<0.05);(2)肺动脉收缩压:A与B、B与C、A与C比较差异均有统计学意义(均P<0.05);(3)动脉血氧分压:A与B比较差异无统计学意义(P>0.05),C与A、C与B比较差异均有统计学意义(均P<0.05)。(2)三组患者总有效率比较,经χ~2检验,差异有统计学意义(χ~2=8.750,P=0.013),A组与B组比较,差异无统计学意义(P>0.0125);A组与C组比较,差异有统计学意义(P<0.0125),B组与C组比较,差异无统计学意义(P>0.0125)。(3)溶栓后3d内三组患者总出血率比较,差异无统计学意义(χ~2=1.241,P=0.538)。结论r-PA两次静脉推注溶栓效果最好,r-PA单次静脉推注与r-PA单次静脉泵入疗效近似,三组的不良反应无显著差异。r-PA两次静脉推注可能是一种更有效、安全的APTE溶栓治疗方法。
Objective To study the effect of three different administrations of reteplase( r-PA) in patients with early large area acute pulmonary thromboembolism( APTE). Methods From January 2013 to December 2016,90 APTE patients complicated with thrombolysis indication were randomly divided into three groups. In the group A,18 mg of r-PA was dissolved in 50 ml normal saline,and then it was intravenous dripped by micro-pump in two hours. In the group B,18 mg of r-PA dissolved in 10 ml normal saline,and then it was injected intravenously,time longer than 2 minutes. In the group C,18 mg of r-PA dissolved in 10 ml normal saline,and then it was injected intravenously twice,each time more than 2 minutes. The interval time was 30 minutes. The changes of right ventricle inner diameter,pulmonary artery systolic pressure,arterial partial pressure of oxygen were observed and compared before and 24 hours after thrombolysis,to evaluate thrombolytic therapy. Bleeding complications were observed within3 days after thrombolysis. Results( 1) 24 hours after thrombolysis,the right ventricle inner diameter,pulmonary artery systolic pressure and arterial partial pressure of oxygen in the three groups were significantly improved( all P <0. 01). Multiple comparison of the three groups 24 hours after thrombolytic showed:(1) Right ventricle inner diameter: there was no significant difference between the group A and B( P > 0. 05),but there was significant difference between the group C and A,and C and B( all P < 0. 05);(2) Pulmonary artery systolic pressure: there was no significant difference between the group A and B,B and C,A and C( P < 0. 05).(3) Arterial partial pressure of oxygen:there was no significant difference between the group A and B( P > 0. 05),but there was significant difference between the group C and A,and C and B( P < 0. 05).( 2) The total effective rate of the three groups were statistically significant( χ~2= 8. 750,P = 0. 013). Among which,there was no significant difference between the A group and the B group( P > 0. 0125). There was significant difference between the A group and the C group( P < 0. 0125). There was no significant difference between the B group and the C group( P > 0. 0125).( 3) There was no significant difference in bleeding rate among the three groups after thrombolysis within 3 days( χ~2= 1. 241,P = 0. 538). Conclusion r-PA twice intravenous injection is the best method in the thrombolytic effect,and the effect is approximation between r-PA single intravenous bolus injection and r-PA single. There is no significant difference in adverse reactions among the three groups,and r-PA twice intravenous bolus may be a more effective and safe thrombolytic therapy for APTE.
出处
《临床肺科杂志》
2017年第9期1558-1562,共5页
Journal of Clinical Pulmonary Medicine
基金
2005年度国家级火炬计划项目(No 2005EB020877)
关键词
肺血栓栓塞症
早期
大面积
瑞替普酶
给药方式
pulmonary thromboembolism
early
large area
reteplase
drug administration
