Page 76 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第43卷第2期
·218 · Journal of Nanjing Medical University（Natural Sciences） 2023年2月

·临床医学·

中高危急性肺血栓栓塞症患者溶栓治疗的临床特征分析

田雪婧，朱 毅，孔 辉，何梦钰，解卫平，李 南 *
南京医科大学第一附属医院呼吸与危重症医学科，江苏 南京 210029

［摘 要］ 目的：回顾性分析中高危急性肺血栓栓塞症（acute pulmonary thromboembolism，APTE）患者临床特征、治疗及预后，
为中高危APTE患者治疗策略的选择提供依据。方法：收集南京医科大学第一附属医院2016年1月—2019年6月符合标准的
住院中高危APTE患者55例，根据是否溶栓治疗分为溶栓组（n=27）和非溶栓组（n=28），比较溶栓组和非溶栓组的临床资料，分
析溶栓组溶栓治疗的原因，采用Logistic回归分析中高危APTE患者溶栓治疗的相关因素，比较不同治疗方案患者的预后及不
良事件发生率。结果：溶栓组中急诊首诊、双侧APTE、中央型APTE比例高于非溶栓组，但右心室增大/收缩功能障碍的比例低
于非溶栓组，差异有统计学意义（P < 0.05）。性别、下肢深静脉血栓形成、中⁃重度肺动脉高压、基础疾病（包括慢性肺部疾病、
高血压、糖尿病、冠心病、脑血管病史、恶性肿瘤）对是否溶栓治疗无明显影响。溶栓组患者D⁃二聚体、中性粒细胞百分比高于
非溶栓组，外周血氧饱和度（peripheral oxygen saturation，SpO2 ）显著降低（P < 0.05），动脉血氧分压（arterial partial pressure of ox⁃
ygen，PaO2 ）有下降趋势。高敏肌钙蛋白T、N⁃末端脑钠肽前体在溶栓组呈升高趋势，但差异无统计学意义。Logistic回归和受
试者工作特征（receiver operating characteristic，ROC）曲线分析显示，SpO2为溶栓治疗重要因素（P < 0.05），其最佳临界值为
91.5%。两组患者的院内病死率均为0，但全身溶栓的出血发生率高于导管直接溶栓或单纯抗凝治疗（P < 0.05）。结论：中高
危APTE患者行溶栓治疗的原因包括SpO2低、临床症状严重、血栓负荷重、心脏负荷重。相比导管直接溶栓和单纯抗凝治疗，
全身溶栓治疗的中高危APTE患者出血风险升高。
［关键词］ 急性肺血栓栓塞症；中高危；溶栓；预后
［中图分类号］ R563.5 ［文献标志码］ A ［文章编号］ 1007⁃4368（2023）02⁃218⁃07
doi：10.7655/NYDXBNS20230210

Clinical analysis of thrombolytic therapy in patients with acute intermediate ⁃ high risk
pulmonary embolism
TIAN Xuejing，ZHU Yi，KONG Hui，HE Mengyu，XIE Weiping，LI Nan *
Department of Respiratory and Critical Care Medicine，the First Affiliated Hospital of Nanjing Medical University，
Nanjing 210029，China

［Abstract］ Objective：To retrospectively analyze the clinical characteristics，treatment and prognosis of intermediate⁃high risk acute
pulmonary thromboembolism（APTE）patients，and to further provide basis for the selection of treatment strategies for intermediate⁃high
risk APTE patients. Methods：A total of 55 hospitalized intermediate⁃high risk APTE patients who met the criteria from January 2016
to June 2019 in the First Affiliated Hospital of Nanjing Medical University were divided into the thrombolytic group（n=27）and the non⁃
thrombolytic group（n=28）according to whether thrombolytic therapy was performed. The clinical data of the thrombolytic group and
the non⁃thrombolytic group were compared，and the causes of thrombolytic therapy in the thrombolytic group were analyzed. Logistic
regression was used to analyze the factors related to thrombolytic therapy in the intermediate⁃high risk APTE patients，and to compare
the prognosis and incidence of adverse events in patients with different treatment regimens. Results：The proportion of first emergency
visit，bilateral APTE and central APTE in the thrombolytic group was higher than that in the non⁃thrombolytic group，but the proportion
of right ventricular enlargement/systolic dysfunction was lower than that in the non⁃thrombolytic group，the difference was statistically
significant（P < 0.05）. Gender，lower extremity deep venous thrombosis，moderate to severe pulmonary hypertension，underlying
diseases（including chronic pulmonary disease，hypertension，diabetes，coronary heart disease，cerebrovascular history，and malignant

［基金项目］ 国家自然科学基金（82000061）
∗
通信作者（Corresponding author），E⁃mail：njlnan@njmu.edu.cn