溶栓加抗凝疗法与单纯抗凝疗法对次大面积肺栓塞的疗效及远期预后的影响临床医学.docVIP

溶栓加抗凝疗法与单纯抗凝疗法对次大面积肺栓塞的疗效及远期预后的影响临床医学 目录 TOC \o 1-9 \h \z \u 目录 1 正文 1 文1：溶栓加抗凝疗法与单纯抗凝疗法对次大面积肺栓塞的疗效及远期预后的影响临床医学 1 1资料与方法 3 文2：比较连续性肾脏替代疗法与间歇性血液透析治疗尿毒症脑病的疗效 6 1 资料与方法 6 2 结果 7 3 讨论 8 参考文摘引言： 8 原创性声明（模板） 10 文章致谢（模板） 10 正文 溶栓加抗凝疗法与单纯抗凝疗法对次大面积肺栓塞的疗效及远期预后的影响临床医学 文1：溶栓加抗凝疗法与单纯抗凝疗法对次大面积肺栓塞的疗效及远期预后的影响临床医学 Abstract： ObjectiveTo analyze the efficiency of thrombolytic therapy and anticoagulative therapy in the patients with submassive pulmonary embolism and their safety, and to observe the rate of eventfree survival after one year’s followup. MethodsA total of 106 patients with documented submassive pulmonary embolism were divided into two groups at random. Group A (n=51) was treated with thrombolysis (urokinase) combined with anticoagulant therapy (low molecular weight heparin and warfarin), and Group B (n=55) with simple anticoagulant therapy. All the patients were followed up one year for the observation of the incidences of the events (recurrent pulmonary embolism, severe bleeding, and death). ResultsThe effective rate was % (46/51) in Group A and % (37/55) in GroupB. The occurrence of bleeding in Group A was % (1/51), and none bled in Group B. There was no difference in the probability of primary endpoint event in the patients with different treatment after one year’s followup. Major events occurred in 4 cases (%) of Group A and in 6 cases (%) of Group B. ConclusionThrombolytic therapy with urokinase combined with low molecular weight heparin is effective and safe for submassive pulmonary embolism, but it does not bring forth the decline of eventfree survival rate after one year when compared with simple anticoagulation. Key words： pulmonary embolism; thrombolytic therapy; urokinase; lowmolecular weight heparin 急性肺栓塞症(Pulmonary embolism， PE)临床并不少见，在西方国家其发病率在血管病中仅次于冠心病和原发性高血压，但住院病死率却高达25%~30%［1］，严重威胁患者的生命。对于PE的治疗目前达成的共识是：小肺栓塞抗凝治疗有效，不需溶栓；大面积肺栓塞溶栓可以降低死亡率，应首选；而次大面积肺栓塞溶栓存在争议。为此，2003年8月—2006年8月，我们对确诊的106例次大面积肺栓塞患者，分别行溶栓加抗凝疗法和单纯抗凝疗法，观察其有效性和安