小剂量尿激酶治疗具有溶栓相对禁忌证的肺栓塞患者的临床观察.pdfVIP

论 著 小剂量尿激酶治疗具有溶栓相对禁忌证的肺栓塞患者的 临床观察① 石松菁 林兴盛 (福建省立医院重症内科 福建福州 350001) 【摘要】目的 探讨小剂量尿激酶溶栓治疗对具有溶栓相对禁忌证的急性肺栓塞患者的疗效及安全性 。方法 将具有溶栓相对禁忌 证 、病情危重的39倒肺栓塞患者，每 日1次用小剂量尿激酶(50万Iu)2h溶栓治疗，连用3～7d。同时监测血凝，每次于溶后2h~lL据APTT值开 始肝素抗凝。观察其疗效及并发症。结果 溶栓过程中均未见有大出血。39例中，死亡6例(3倒死于顽固性低氧血症，3例死于原发病)，其 余33例患者症状明显改善。结论 具有溶拴相对禁忌证的肺栓塞患者，用小剂量尿激酶溶栓治疗，具有良好的临床疗效及安全性。 【关键词】肺栓塞 尿激酶 溶栓治疗 肝素 【中图分类号JR743．3 【文献标识码JA 【文章编号l1674--0742(2010)03(b)-0002-02 ClinicalObservation aboutLow-doseUrokinaseforAcutePulmonary Embolism ofthe Patientswith RelativeThromblytic C0ntraindicati0ns 【Abstract]Objective Todiscusstheefficacyandsafetyofthromblytictherapyusing1ow--doseur0kinase(uK)onthetreatmentof acute pulmonary embolism of the patientswith relative thromblytic contraindications．Methods 39 criticalpatientswith acute pulmonary embolism，who werealsoconsided with relative thromblyticcontraindications，received 2hour thromblytictherapy with UK atalow doseof50X104IU．Oncea dayandfor3～7daysaccording thesymptom．Atthe sametimethecoagulogram WaSmonitored． The heparin was given firstly forantic0agulati0n two hourslate after thromblytictherapy when APTT reached the requirement． Clinicaleffectand Complication were observed．Results Through the treatment，the patientsshowed no seriousbleeding．Among the 39patients，6casesweredead(3casesweredieintherefractorinesshypoxemia，3casesweredieintheprimary affection)，the rest33caseshad significantimprovement．Conclusion Thromblytictherapy using low--dose UK on the treatmentofacute pulmonary embolism has achieved significant clinical outcome and its safety has been validated to patients with relative thromblytic c0ntraindicatiOns． [Key Words】Pulmonary embolism；Urokinase：Thromblytic therapy；Heparin 肺动脉血栓栓塞症，简称肺栓塞(PE)是猝死的常见病因，在我 1．2