Zhao H G, Wang S X, Lu Z N, Yan X X, Lyu Z C, Peng F H, Wu Y, Gao X, Hua L, Jing Z C, Xu X Q
Medical Academy of Hebei University, Baoding 071000, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2017 Apr 24;45(4):314-317. doi: 10.3760/cma.j.issn.0253-3758.2017.04.011.
To assess the efficacy and safety of thrombolytic treatment with reteplase in patients with intermediate-risk acute pulmonary embolism. Ten consecutive patients with intermediate-risk acute pulmonary embolism who received thrombolytic treatment with reteplase at Thrombosis and Vascular Medicine Center, Fuwai Hospital from March to November in 2016 were included.Vital signs, right ventricular diameter, systolic pulmonary artery pressure, and biochemical markers were assessed before and after thrombolytic therapy with reteplase, and bleeding complications were also observed during 3 months follow up. (1) For the efficacy outcomes: at 48 hours after thrombolytic treatment with reteplase, echocardiography-derived diameter of right ventricular was significant reduced from (27.9±3.8) mm to (24.8±2.6) mm (=0.03), systolic pulmonary artery pressure decreased from (63.9±21.6) mmHg(1 mmHg=0.133 kPa) to (34.4±19.8) mmHg (=0.02). Heart rate and breathing rate were also decreased significantly (both <0.05), blood pressure remained unchanged post therapy.Hypoxemia was quickly corrected with an significant elevation of PaO(2) and SaO(2) ((65.2±14.3) mmHg vs. (80.0±9.6) mmHg, =0.006; (90.8±3.5)% vs. (95.2 ±1.6)%, =0.002 respectively). PaCO(2) was also increased significantly (<0.05). Serum NT-proBNP and cTnI were decreased significantly (both <0.05). There was no recurrent pulmonary embolism or deep-vein thrombosis during the 3 months follow-up. (2) For the safety outcomes: a thrombolytic relevant hemoptysis (about 70 ml) occurred in 1 patient, and was controlled by PCC therapy.No other clinically relevant events were observed during thrombolytic treatment. Eight patients were followed more than 3 months, there was no major bleeding complication or death during the follow up period. Treatment of intermediate-risk acute pulmonary embolism with reteplase is effective and safe and there are no obvious side effects.
评估瑞替普酶溶栓治疗中度风险急性肺栓塞患者的疗效和安全性。纳入2016年3月至11月在阜外医院血栓与血管医学中心接受瑞替普酶溶栓治疗的10例连续的中度风险急性肺栓塞患者。在瑞替普酶溶栓治疗前后评估生命体征、右心室直径、肺动脉收缩压和生化标志物，并在3个月随访期间观察出血并发症。（1）疗效结果：瑞替普酶溶栓治疗48小时后，超声心动图测得的右心室直径从（27.9±3.8）mm显著减小至（24.8±2.6）mm（P=0.03），肺动脉收缩压从（63.9±21.6）mmHg（1 mmHg = 0.133 kPa）降至（34.4±19.8）mmHg（P=0.02）。心率和呼吸频率也显著降低（均P<0.05），治疗后血压保持不变。低氧血症迅速得到纠正，PaO₂和SaO₂显著升高（（65.2±14.3）mmHg对（80.0±9.6）mmHg，P=0.006；（90.8±3.5）%对（95.2±1.6）%，P=0.002）。PaCO₂也显著升高（P<0.05）。血清NT-proBNP和cTnI显著降低（均P<0.05）。在3个月随访期间未发生复发性肺栓塞或深静脉血栓形成。（2）安全性结果：1例患者发生溶栓相关咯血（约70 ml），经PCC治疗得到控制。溶栓治疗期间未观察到其他临床相关事件。8例患者随访超过3个月，随访期间未发生严重出血并发症或死亡。瑞替普酶治疗中度风险急性肺栓塞有效且安全，无明显副作用。
