本文選題：急性肺血栓栓塞癥 + 尿激酶�。� 參考：《廣西醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的：探討溶栓加抗凝療法與單純抗凝療法對中危組急性肺血栓栓塞癥(PTE)患者的治療效果,以提高臨床對該病的認(rèn)識,提高診療水平,降低該病的死亡率。 方法：收集廣西醫(yī)科大學(xué)第一附屬醫(yī)院2010年1月至2012年12月期間確診為中危組的急性肺栓塞患者的臨床資料,對其進(jìn)行回顧性分析,根據(jù)治療情況分組,A組為予尿激酶20000U/kg靜脈滴注2小時,溶栓結(jié)束后,開始予以皮下注射低分子肝素治療,并重疊口服華法林,之后則單純應(yīng)用華法林,直至INR達(dá)到正常的2-3倍。B組為只用低分子肝素和華法林抗凝。分別治療2周,對比兩組患者的臨床癥狀、體征、呼吸頻率、心率、動脈血氧分壓(Pa02)、二氧化碳分壓(PaCO2)、心肌肌鈣蛋白Ⅰ(CTnI)、心臟彩超、螺旋CT肺動脈造影(CTPA)的變化情況及臨床療效,并觀察其并發(fā)癥情況。 結(jié)果：觀察組A組為37例,男性30例,女性7例,年齡為53.1+16.42歲；對照組B組為41例,男性31例,女性10例,年齡為51.8±14.66歲。治療后兩組臨床癥狀、體征均有好轉(zhuǎn),呼吸頻率、心率、肌鈣蛋白I均顯著降低(尸0.05);PaO2、PaCO2等血?dú)庵笜?biāo)治療后兩組均顯著改善(P0.05或0.01)；CTPA示治療總有效率A組顯著高于B組(P0.01),心臟彩超示室壁運(yùn)動改善,肺動脈壓力較前降低,A組與B組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),A組優(yōu)于B組。兩組臨床療效比較,A組總有效率明顯高于B組,兩組間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。A組并發(fā)出血、血小板減少、肝腎功能損害較B組增多,A、B兩組不良反應(yīng)發(fā)生率分別為13.5%、4.88%,但兩者比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論：對于中危組急性PTE的患者,尿激酶溶栓加序貫抗凝治療優(yōu)于單純抗凝治療,但其不良反應(yīng)發(fā)生率高于單純抗凝治療,需提高該方面的警惕性。
[Abstract]:Objective: to investigate the effect of thrombolytic therapy combined with anticoagulant therapy and simple anticoagulant therapy on patients with moderate risk acute pulmonary thromboembolism (Pte) in order to improve the clinical understanding of the disease, improve the level of diagnosis and treatment, and reduce the mortality of the disease. Methods: the clinical data of patients with acute pulmonary embolism diagnosed in the first affiliated Hospital of Guangxi Medical University from January 2010 to December 2012 were collected and analyzed retrospectively. According to the treatment condition, group A was given urokinase 20000Ukg intravenously for 2 hours. After thrombolysis, low molecular weight heparin was injected subcutaneously, warfarin was given orally, then warfarin was used only. Only low molecular weight heparin and warfarin anticoagulant were used in group B until the INR was 2-3 times normal. The clinical symptoms, signs, respiratory frequency, heart rate, arterial partial pressure of oxygen (Pa02), partial pressure of carbon dioxide (PaCO2), cardiac troponin I (CTnI), color echocardiography, spiral CT pulmonary arteriography (CTPA) were compared between the two groups. The complications were observed. Results: there were 37 cases in group A, 30 males and 7 females, aged 53.1 16.42 years, and 41 cases in group B, 31 males and 10 females, aged 51.8 鹵14.66 years. After treatment, the clinical symptoms and signs of the two groups were improved, the respiratory rate, heart rate and troponin I were significantly decreased (P < 0.05) and the blood gas indexes such as PaO2 and Paco _ 2 were significantly improved in the two groups (P0.05 or 0.01). CTPA showed that the total effective rate of group A was significantly higher than that of group B (P0.01), cardiac color Doppler echocardiography showed the improvement of ventricular wall motion, pulmonary artery pressure was lower in group A than in group B (P0.05). The total effective rate of group A was significantly higher than that of group B, the difference between the two groups was statistically significant (P0.05) .A group complicated with hemorrhage, thrombocytopenia, The incidence of adverse reactions in group A and B was 13.5and 4.88 respectively, but there was no significant difference between the two groups (P0.05). Conclusion: urokinase thrombolytic therapy plus sequential anticoagulant therapy is superior to anticoagulant therapy alone, but the incidence of adverse reactions is higher than that of anticoagulant therapy alone.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R563.5

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