蚓激酶对急性中危肺血栓栓塞患者治疗的临床疗效观察

目的 探讨蚓激酶对急性中危肺血栓栓塞患者治疗中的疗效及安全性。方法 选择2010年1月至2015年10月在我院住院治疗的60例急性中危肺血栓栓塞患者进行前瞻性队列研究，患者分为治疗组（蚓激酶联合低分子肝素钠序贯华法林组）30例和对照组（低分子肝素钠序贯华法林组）30例，根据不同时期两组各分为治疗前、治疗后10 d、治疗后20 d和治疗后30 d亚组。比较治疗前、治疗后10 d、20 d及30 d临床疗效及安全性。结果 超声心动图结果表明蚓激酶组右心室最大短轴直径、左心室最大短轴直径、右心室最大短轴与左心室最大短轴直径比值、肺动脉收缩压和主肺动脉直径值在治疗后10 d、20 d及30 d与对照组比较差异显著，且两组组间比较差异均有统计学意义（P<0.05）。与对照组比较，蚓激酶组NT-proBNP在治疗后10 d、20 d和30 d显著降低，而PaO₂值在治疗后10 d、20 d和30 d明显升高，且对照组和蚓激酶组各亚组组间的NT-proBNP和PaO₂值比较差异均有统计学意义（P<0.05）。D-二聚体在对照组和蚓激酶组治疗后10 d明显增高，而在治疗后20 d、30 d显著降低，且两组及组间比较差异均显著，具有统计学意义（P<0.05）。结论 蚓激酶联合低分子肝素钠序贯华法林治疗急性中危肺血栓栓塞患者临床疗效好且安全，值得临床推广应用。

Effect of Lumbrokinase on Patients with Actue Moderate Risk Pulmonary Thromboembolism

Objective To explore the curative effective and safety of lumbrokinase in the treatment of actue moderate risk pulmonary thromboembolism. Methods The 60 patients with actue moderate risk pulmonary thromboembolism from January 2010 to October 2015 in our hospital were enrolled in the prospective cohort study. 60 patients with actue moderate risk pulmonary thromboembolism were divided into the lumbrokinase group (lumbrokinase in combination with low molecular heparin sodium and sequential warfarin) and control group (low molecular heparin sodium and sequential warfarin), 30 patients in each group. According to different periods, each group was divided into before treatment, after treatment for 10 d, 20 d and 30 d subgroups, and the curative effective and safety were compared. Results Compared with control group, maximum short axis diameter, ratio of right and left ventricles, systolic pulmonary artery pressure, and the main pulmonary artery diameter measured by echocardiography of lumbrokinase group were significantly different in after treatment for 10 d, 20 d and 30 d subgroups, and there was a statistical significance between each group (P<0.05). NT-proBNP of lumbrokinase group in after treatment for 10 d, 20 d and 30 d subgroups reduced significantly, howover, the value of PaO₂ increased significantly (P<0.05). D-dimer in the two groups increased obviously after treatment for 10 d, and reduced significantly after treatment for 20 d and 30 d, and the differences between the two groups and subgroups were significant, with statistical significance (P<0.05). Conclusion The therapeutic method of lumbrokinase combined with low molecular heparin sodium and sequential warfarin shows good and safety clinical effect. It is worthy of clinical popularization and application.