Lang M, Charbonnier B, Quilliet L, Pacouret G, Poitrineau O, Mannara R, Neel G, Desveaux B, Raynaud P, Brochier M L
Clinique cardiologique, CHU Trousseau, Tours.
Arch Mal Coeur Vaiss. 1989 Nov;82(11):1803-11.
Twenty six patients with acute (less than 5 days) pulmonary embolism (PE) confirmed by bilateral pulmonary angiography with a Miller index greater than 15 were given tissue plasminogen activator (Alteplase) (rt-PA) intravenously (n = 20) or directly into the pulmonary artery (n = 6). The dosage was 100 mg/7 hours (bolus 10 mg + 40 mg/2 hours + 50 mg/5 hours). Heparin (5000 IV as a bolus and 1000 IV/hour) was associated in all cases. The Miller index decreased from 24 +/- 1 (n = 26) before treatment to 12 +/- 1 (n = 25) (p less than 0.001) after 100 mg of Alteplase, and from 25 +/- 0.4 (n = 14) to 22 +/- 0.5 (n = 14) (p less than 0.001) after 50 mg. The mean pulmonary arterial pressures fell from 30 +/- 2 mmHg to 21 +/- 2 mmHg after 50 mg (n = 26) (p less than 0.001) and to 14 +/- 1 (n = 25) (p less than 0.001) after 100 mg of Alteplase. A decrease in mean pulmonary artery pressures (-22%, p less than 0.001) and total pulmonary resistances (-29%, p less than 0.001) was obtained after one hour of thrombolysis in 12 monitored patients. There were no fatalities. Severe haemorrhage occurred in 6 cases. Therefore, Alteplase induced a rapid dissolution of recent intrapulmonary thrombi without inacceptable haemorrhagic complications. Its action could be particularly beneficial in patients with right ventricular failure due to life threatening pulmonary embolism.
26例经双侧肺血管造影证实为急性（病程小于5天）肺栓塞（PE）且米勒指数大于15的患者，接受了静脉注射（n = 20）或直接注入肺动脉（n = 6）的组织型纤溶酶原激活剂（阿替普酶）（rt - PA）治疗。剂量为100 mg/7小时（静脉推注10 mg + 40 mg/2小时 + 50 mg/5小时）。所有病例均联合使用肝素（静脉推注5000单位，然后1000单位/小时）。在给予100 mg阿替普酶后，米勒指数从治疗前的24±1（n = 26）降至12±1（n = 25）（p < 0.001），给予50 mg后，从25±0.4（n = 14）降至22±0.5（n = 14）（p < 0.001）。平均肺动脉压在给予50 mg后从30±2 mmHg降至21±2 mmHg（n = 26）（p < 0.001），给予100 mg阿替普酶后降至14±1（n = 25）（p < 0.001）。在12例接受监测的患者中，溶栓1小时后平均肺动脉压下降（-22%，p < 0.001），总肺阻力下降（-29%，p < 0.001）。无死亡病例。6例发生严重出血。因此，阿替普酶能迅速溶解近期肺内血栓，且无不可接受的出血并发症。其作用对因危及生命的肺栓塞导致右心室衰竭的患者可能特别有益。
