Chest. 1990 Mar;97(3):528-33. doi: 10.1378/chest.97.3.528.
Thirteen patients with acute pulmonary embolism were treated in a randomized double-blind fashion either with recombinant tissue plasminogen activator (rt-PA) 40 to 80 mg, usually in combination with heparin, or with placebo plus heparin. The drug was administered intravenously over 40 to 90 minutes. Nine patients received rt-PA, and four received placebo. A lytic effect was observed 1.5 and three hours after the onset of therapy with rt-PA based upon elevated levels of fragment-D dimers. Among the patients who received rt-PA, there was a modest improvement of the total pulmonary resistance 1.5 hours after the start of therapy, but the angiograms showed no significant changes in two hours. After 24 hours, the lung scans showed a trend toward greater improvement with rt-PA, but the rate of improvement in comparison to control subjects was not statistically significant. Massive bleeding occurred in one patient. The observations in this study suggest that rt-PA has little effect in two hours on angiographic clot burden, but may produce some improvement in hemodynamics. The treatment, however, is not without risk.
13例急性肺栓塞患者以随机双盲方式接受治疗，其中9例接受40至80毫克重组组织型纤溶酶原激活剂（rt-PA）治疗，通常联合肝素使用；另外4例接受安慰剂加肝素治疗。药物在40至90分钟内静脉输注。9例患者接受rt-PA治疗，4例接受安慰剂治疗。基于D-二聚体水平升高，在rt-PA治疗开始后1.5小时和3小时观察到溶栓效果。在接受rt-PA治疗的患者中，治疗开始后1.5小时总肺阻力有适度改善，但血管造影显示两小时内无明显变化。24小时后，肺部扫描显示rt-PA治疗有更大改善的趋势，但与对照组相比改善率无统计学意义。1例患者发生大出血。本研究的观察结果表明，rt-PA在两小时内对血管造影显示的血栓负荷影响不大，但可能在血流动力学方面产生一些改善。然而，这种治疗并非没有风险。
