發(fā)布時(shí)間：2018-06-05 04:06

  本文選題：中危 + 急性肺栓塞��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]探討單純抗凝與溶栓聯(lián)合抗凝在中危急性肺血栓栓塞(acute pulmonary thromboembolism APTE)患者中的治療應(yīng)用及臨床效果。[方法]選擇2016年01月01日至2016年12月31日一年來(lái)就診昆明醫(yī)科大學(xué)附屬第四醫(yī)院云南省血管外科中心的中危APTE患者,患者入院后后告知患者單純抗凝治療及溶栓聯(lián)合抗凝治療兩種方案,讓患者自主選擇并簽署治療同意書。選擇單純抗凝治療的患者入A組(對(duì)照組)31例,選擇溶栓聯(lián)合抗凝治療的患者入B組(實(shí)驗(yàn)組)35例,共計(jì)66例,根據(jù)患者治療前后臨床癥狀、復(fù)查肺動(dòng)脈CTA、心臟彩超等評(píng)估治療效果。[結(jié)果]1、治療后兩組患者的臨床癥狀均得到不同程度的改善,分別比較二組患者治療前后指標(biāo):肺栓塞面積(段數(shù))減小,肺動(dòng)脈收縮壓(pulmonary artery systolic pressure PASP)下降,氧分壓及氧飽和度也明顯改善,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組間治療后指標(biāo)改善程度比較,氧分壓及氧飽和度差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),肺栓塞面積(段數(shù))及PASP差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2、比較兩組患者治療后療效,A組總有效率77.42%;B組總有效率97.15%,對(duì)比兩組差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3、兩組患者出血并發(fā)癥的比較,A組出血患者6例,出血發(fā)生率為19.35%;B組出血患者8例,出血發(fā)生率為22.86%。對(duì)比兩組差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。[結(jié)論]1、對(duì)于中危APTE患者應(yīng)用溶栓聯(lián)合抗凝治療與單純抗凝治療后臨床癥狀均可得到改善。2、采用小劑量尿激酶溶栓聯(lián)合抗凝治療效果優(yōu)于單純抗凝治療且并未增加出血風(fēng)險(xiǎn)。
[Abstract]:[objective] to investigate the application and clinical effect of anticoagulation combined with thrombolytic therapy in patients with acute pulmonary thromboembolism (pulmonary thromboembolism APTE). [methods] Intermediate risk APTE patients in Yunnan Provincial Vascular surgery Center, fourth affiliated Hospital of Kunming Medical University, from January 01, 2016 to December 31, 2016, were selected. After admission, patients were informed of only anticoagulant therapy and thrombolytic therapy combined with anticoagulant therapy. Patients with anticoagulant therapy were selected into group A (control group, 31 cases) and group B (group B, 35 patients with thrombolytic therapy combined with anticoagulant therapy). According to the clinical symptoms of the patients before and after treatment, The therapeutic effect was evaluated by reexamination of pulmonary artery CTAA and color Doppler echocardiography. [results] 1. After treatment, the clinical symptoms of the two groups were improved to varying degrees. The indexes before and after treatment were compared: pulmonary embolism area (number of segments) decreased, pulmonary systolic blood pressure (PAP) and pulmonary artery systolic pressure PASP) decreased. The oxygen partial pressure and oxygen saturation also improved obviously, the difference was statistically significant (P 0.05). Comparison of the degree of improvement of indexes after treatment between the two groups, There was no significant difference in oxygen partial pressure and oxygen saturation (P 0.05), but there was significant difference in pulmonary embolism area (number of segments) and PASP between two groups. The total effective rate of group A was compared with that of group A after treatment. The total effective rate of group B was 97.15%, and the difference between two groups was statistically significant. Comparison of bleeding complications in two groups A group (n = 6) had hemorrhage. The bleeding rate was 19.35% and 22.86% in group B. There was no significant difference between the two groups (P 0.05). [conclusion] 1. The clinical symptoms of moderate risk APTE patients were improved after thrombolysis combined with anticoagulant therapy and only anticoagulant therapy. The effect of low dose urokinase combined anticoagulant therapy was better than that of simple anticoagulant therapy and did not increase the risk of bleeding.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 杜辛歌;王迎難;倪吉祥;程燕雯;吳巧玲;;間斷小劑量尿激酶溶栓治療肺栓塞的療效[J];臨床肺科雜志;2016年06期

2 楊國(guó)凱;楊鏞;萬(wàn)嘉;馬振桓;李國(guó)劍;陸平;杜玲娟;;小劑量阿替普酶聯(lián)合尿激酶在急性肺栓塞治療中的臨床研究[J];臨床醫(yī)學(xué);2016年01期

3 梁彩霞;;小劑量rt-PA溶栓治療急性肺栓塞效果觀察[J];臨床肺科雜志;2014年07期

4 畢喜兵;苑敏;王遠(yuǎn)東;;瑞替普酶溶栓治療急性大面積肺栓塞的療效分析[J];中國(guó)醫(yī)藥指南;2014年08期

5 張朝順;馮起校;覃善君;;中危(次大面積)急性肺栓塞患者是否需要溶栓治療[J];新醫(yī)學(xué);2014年03期

6 鄒治鵬;何建國(guó);程顯聲;趙彥芬;陳白屏;高瑩;熊長(zhǎng)明;倪新海;荊志誠(chéng);;230例急性肺動(dòng)脈血栓栓塞癥患者對(duì)癥治療、抗凝治療和溶栓治療的住院轉(zhuǎn)歸[J];中國(guó)循環(huán)雜志;2006年03期

7 馬俊義;袁雅冬;;肺血栓栓塞癥的現(xiàn)代藥物治療新指南[J];實(shí)用心腦肺血管病雜志;2006年02期

8 荊志成,鄧可武;急性肺動(dòng)脈血栓栓塞癥的溶栓治療[J];中華醫(yī)學(xué)雜志;2004年22期

9 柳志紅,趙彥芬;急性肺栓塞的診斷治療現(xiàn)狀[J];中國(guó)循環(huán)雜志;2002年03期

10 何建國(guó),程顯聲,高明哲,陳光瑾,李樹花,張中和,趙鳴武,周素敏,趙濟(jì)文,成立珠,張珍祥,陳玉林,王樂(lè)民,顧晴,吳振軍;全國(guó)21家醫(yī)院急性肺栓塞診治情況的調(diào)查分析[J];中華醫(yī)學(xué)雜志;2001年24期

，

本文編號(hào)：1980422