Verstraete M, Miller G A, Bounameaux H, Charbonnier B, Colle J P, Lecorf G, Marbet G A, Mombaerts P, Olsson C G
Center for Thrombosis and Vascular Research, Campus Gasthuisberg, Leuven, Belgium.
Circulation. 1988 Feb;77(2):353-60. doi: 10.1161/01.cir.77.2.353.
Eight centers participated in a study in which intrapulmonary and intravenous administration of recombinant tissue-type plasminogen activator (rt-PA) were compared in 34 patients with acute massive pulmonary embolism. All patients received intravenous heparin in a bolus of 5,000 IU followed by 1,000 IU/hr. After 50 mg rt-PA given over 2 hr the severity of embolism, determined from pulmonary angiograms, declined by 12% in the intrapulmonary drug group (p less than .005) and 15% in the intravenous drug group (p less than .005); mean pulmonary arterial pressure fell from 31 +/- 7 to 22 +/- 6 mm Hg (p less than .005) and from 31 +/- 12 to 21 +/- 9 mm Hg (p less than .005) in the respective groups. After a further 50 mg given over 5 hr (22 patients), the angiographically determined severity of embolism had decreased by 38% from baseline in the intrapulmonary drug group and by 38% in the intravenous drug group. The mean pulmonary arterial pressure further declined to 18 +/- 7 and 12 +/- 5 mm Hg in the respective groups. Fibrinogen levels dropped to 48% of baseline after 50 mg and to 36% of baseline after 100 mg rt-PA. Some degree of bleeding at puncture and/or operation sites was noted in 16 patients, including four who required a transfusion of two or more units of blood and had been operated on an average of 7.5 days (range 2 to 13) before thrombolytic treatment was started.(ABSTRACT TRUNCATED AT 250 WORDS)
八个中心参与了一项研究，该研究对34例急性大面积肺栓塞患者进行了肺内和静脉注射重组组织型纤溶酶原激活剂（rt-PA）的比较。所有患者均静脉推注5000 IU肝素，随后以1000 IU/小时的速度持续静脉滴注。在2小时内给予50 mg rt-PA后，根据肺血管造影确定，肺内给药组的栓塞严重程度下降了12%（p<0.005），静脉给药组下降了15%（p<0.005）；相应组的平均肺动脉压分别从31±7降至22±6 mmHg（p<0.005）和从31±12降至21±9 mmHg（p<0.005）。在另外5小时内给予50 mg（22例患者）后，肺内给药组经血管造影确定的栓塞严重程度较基线下降了38%，静脉给药组也下降了38%。相应组的平均肺动脉压进一步降至18±7和12±5 mmHg。给予50 mg rt-PA后纤维蛋白原水平降至基线的48%，给予100 mg后降至基线的36%。16例患者在穿刺和/或手术部位出现了一定程度的出血，其中4例需要输注两单位或更多单位的血液，并且在开始溶栓治疗前平均7.5天（范围2至13天）接受了手术。（摘要截短于250字）
