摘要
目的探索肺栓塞致右心功能不全患者的治疗方案,为临床提供治疗依据。方法依据用药的不同将确诊的60例肺栓塞致右心功能不全患者分为四组,尿激酶组(Ⅰ组)、重组组织型纤溶酶原激活剂(rt-PA)组(Ⅱ组)、尿激酶与西地那非合用组(Ⅲ组)、rt-PA与西地那非合用组(Ⅳ组),每组各15例。疗程为1周,观察各组患者治疗前后的临床表现及以下指标:平均肺动脉压力(mPAP)、右心室舒张末期内径(RVD)、三尖瓣反流压差(PGTI)、D-二聚体(D-D)、动脉血氧分压(PO2)、二氧化碳分压(PCO2)。结果四组患者的临床表现均明显缓解,mPAP、RVD、PGTI、D-D、PO2、PCO2均较治疗前改善(P<0.05)。治疗后各组间比较,mPAP、RVD、PGTI差异有统计学意义(P<0.05),D-D、PO2、PCO2差异无统计学意义(P>0.05),Ⅳ组mPAP、RVD、PGTI下降最明显。结论溶栓、抗凝治疗是肺栓塞致右心功能不全的根本治疗方案,溶栓联合降肺动脉高压治疗疗效显著,rt-PA联合西地那非治疗疗效尤为显著,值得临床推广。
Objective To explore the different treatment regimes to patientswith right ventricular dysfunction induced by pulmonary embolism.Methods 60 patients with right ventricular dysfunction induced by pulmonary embolism were divided into four groups,namely the urokinase group（group Ⅰ）;recombinant tissue type plasminogen activator（rt-PA）group（group Ⅱ）;urokinase and sildenafil in the combination group（group Ⅲ）;rt-PA and sildenafil in the combination group（group Ⅳ）,15 cases in each group.After 1 week of treatment,the clinical manifestation and the following indicators were observed：mean pulmonary artery pressure（mPAP）,right ventricular end-diastolic inner diameter（RVD）,pressure gradient of tricuspid valve regurgitation（PGTI）,D-dimers（D-D）,partial pressure of oxygen（PO2）,pressure of carbon dioxide（PCO2）.Results The clinical manifestations of the four groups were significantly relieved,mPAP,RVD,PGTI,D-D,PO2,PCO2 were improved（P〈0.05）.After treatment,the differences of mPAP,RVD and PGTI were statistically significant among the four groups（P〈0.05）.D-D,PO2,PCO2 had no significant difference（P〈0.05）.mPAP,RVD and PGTI of the Ⅳ group were most obviously decreased.Conclusion To patients with right ventricular dysfunction induced pulmonary embolism,thrombolysis and anticoagulation therapy are theradical therapies,the curative effect of thrombolysis combined with reducing pulmonary arterial hypertension is significant,among which rt-PA combined with sildenafil is particularly significant,worthy of clinical promotion.
出处
《医学综述》
2012年第9期1415-1417,共3页
Medical Recapitulate
关键词
肺栓塞
右心功能不全
尿激酶
重组组织型纤溶酶原激活剂
西地那非
Pulmonary embolism
Right ventricular dysfunction
Urokinase
Recombinant tissue type plasminogen activator
Sildenafil
