Goldhaber S Z, Kessler C M, Heit J, Markis J E, Sharma G V, Dawley D L, Meyerovitz M F, Vaughan D E, Parker J A, Come P C
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115.
J Cell Biochem. 1988 Dec;38(4):303-12. doi: 10.1002/jcb.240380409.
We assessed the efficacy and safety of peripheral intravenous recombinant human tissue-type plasminogen activator (rt-PA) in 47 patients with angiographically documented pulmonary embolism (PE). We administered 50 mg/2 h and, if necessary, an additional 40 mg/4 h. By 6 hours, 94% of the patients had angiographic evidence of clot lysis that was slight in 5, moderate in 12, and marked in 27 patients. Among the 34 patients with pulmonary hypertension prior to treatment, average pulmonary artery pressure decreased from 43/17 (27) to 31/13 (19) mm Hg (P less than 0.0001). The average lung scan perfusion defect decreased from 37% before therapy to 16% (P less than 0.01) after therapy among the 19 patients who had pre- and post-treatment lung scans. Of 7 patients with pre- and post-treatment imaging and Doppler echocardiograms, hypokinetic right ventricular wall movement (mild in 1, moderate in 2, and severe in 4) normalized in 5 and improved to mild hypokinesis in 2. Right ventricular diameter decreased from 3.9 +/- 1.0 to 2.0 +/- 0.5 cm (P less than 0.005). Fibrinogen decreased 33% from baseline at 2 h and 42% from baseline at 6 h. However, patients with the greatest degree of angiographic clot lysis at 2 h had a preponderance of fibrinogenolysis over fibrinolysis, demonstrated by a lower ratio of cross-linked fibrin degradation products to fibrin(ogen) degradation products (0.14 +/- 0.09 vs. 0.54 +/- 0.82) (P less than 0.04). Among selected patients, peripheral intravenous rt-PA is associated with rapid lysis of PE, improved pulmonary perfusion, and improved right ventricular function.
我们评估了外周静脉注射重组人组织型纤溶酶原激活剂（rt-PA）对47例经血管造影证实为肺栓塞（PE）患者的疗效和安全性。我们给予50mg/2小时，必要时额外给予40mg/4小时。至6小时时，94%的患者有血管造影显示的血栓溶解证据，其中5例为轻度，12例为中度，27例为显著。在治疗前有肺动脉高压的34例患者中，平均肺动脉压从43/17（27）mmHg降至31/13（19）mmHg（P<0.0001）。在19例治疗前后均进行肺部扫描的患者中，平均肺部扫描灌注缺损从治疗前的37%降至治疗后的16%（P<0.01）。在7例治疗前后均有影像学检查和多普勒超声心动图检查的患者中，右心室壁运动减弱（1例轻度、2例中度、4例重度）在5例中恢复正常，2例改善为轻度运动减弱。右心室直径从3.9±1.0cm降至2.0±0.5cm（P<0.005）。纤维蛋白原在2小时时较基线水平下降33%，在6小时时较基线水平下降42%。然而，在2小时时血管造影血栓溶解程度最大的患者中，纤维蛋白溶解占优势，表现为交联纤维蛋白降解产物与纤维蛋白（原）降解产物的比例较低（0.14±0.09对0.54±0.82）（P<0.04）。在选定的患者中，外周静脉注射rt-PA与PE的快速溶解、肺灌注改善和右心室功能改善相关。
