摘要
急性肺栓塞(APE)是临床常见的、正确诊断率较低但病死率较高的疾病之一。中医诊断属"脉痹"范畴。发病原因主要包括血栓栓塞、空气栓塞、脂肪栓塞等,但临床上最为常见的是肺动脉及其分支的血栓栓塞,栓子主要来自下肢深静脉血栓栓子脱落。APE西医药物治疗方式主要包括溶栓治疗、抗凝治疗。而中药有效治疗方式仍处于探索阶段,目前主要采用活血化瘀的中药制剂或方剂,通过改善血液高凝状态,促进血栓的溶解和炎症吸收来达到治疗目的。文章归纳阐述近年来中西医药物治疗急性肺栓塞的研究进展。
Acute pulmonary embolism(APE) is one of the most common clinical diseases with a lower correct diagnosis rate and a higher mortality rate.Chinese medicine diagnosis categorizes it into pulse paralysis.The main triggers of the disease include thromboembolism,air embolism and fat embolism.However,the most common clinical cause is pulmonary thromboembolism and its branches,emboli mainly from deep venous thrombosis of the extremities.APE Western meidical treatment includes thrombolytic therapy,anticoagulant therapy.Nonetheless,the effective treatment of traditional Chinese medicine is still in the exploratory stage.The treatment mainly uses traditional Chinese medicine or prescription that prompts blood circulation,aiming to improve blood hypercoagulability and promote the dissolution of thrombus and inflammatory absorption to achieve the purpose of treatment.
引文
[1] 李兰,朱广旗,郭军,等.从“二证二法”探析中医治疗急性肺血栓栓塞症的辨证思路[J].辽宁中医药大学学报,2009,11(7):49-51.
[2] Nagamalesh U M,Prakash V S,Naidu K C K,et al.Acute pulmonary thromboembolism:Epidemiology,predictors,and long-term outcome-A single center experience[J].Indian Heart J,2017,69(2):160-164.
[3] 梁鹏宇,潘霞,任宇豪,等.溶栓酶的研究进展[J].广西科学,2017,24(1):77-82.
[4] 张华山,闫俊鹏,齐义鹏,等.链激酶研究概况及其进展[J].氨基酸和生物资源,2006,28(4):71-73.
[5] 吴丹明,张立魁.溶栓药物分类及合理应用[J].中国实用外科杂志,2011(12):1136-1137.
[6] 韩淑伟.阿替普酶与尿激酶在急性肺栓塞溶栓治疗中的效果比较[J].中外女性健康研究,2017(7):32.
[7] Zhao H G,Wang S X,Lu Z N et al.Clinical efficacy and safety of thrombolytic treatment with reteplase in patients with intermediate-risk acute pulmonary embolism[J].Zhonghua Xin Xue Guan Bing Za Zhi,2017,45(4):314-317.
[8] Liu X Y,Zhang Y,Li M W et al.Efficacy of thrombolytic therapy using reteplase in cases with acute ST-segment elevation myocardial infarction:results from a multicenter clinical trial[J].Zhonghua Xin Xue Guan Bing Za Zhi,2016,44(9):766-770.
[9] Shen Baozhong,Liu Qingan,Gu Yingli,et al.Efficacy and Safety Evaluation on Arterial Thrombolysis in Treating Acute Cerebral Infarction[J].Cell Biochem Biophys,2015,73(2):297-304.
[10] 范军.尿激酶、阿替普酶与瑞替普酶溶栓治疗肺栓塞对比研究分析[J].系统医学,2017,2(8):33-35.
[11] 郭晓书.瑞替普酶治疗肺栓塞的效果探析[J].当代医药论丛,2017,15(2):33-34.
[12] Moreva O V,Kropacheva E S,Dobrovolsky A B,et al.Risk Factors of Recurrent Bleedings at Therapeutic International Normalized Ratio in Patients on Long-Term Warfarin Therapy[J].Kardiologiia,2016,56(2):40-46.
[13] Laura.Warfarin Therapy and the Genotypes CYP2C9 and VKORC1 [M].Bethesda (MD):National Center for Biotechnology Information (US),2012.
[14] 刘晓鹏,王在义.抗凝药物在肺栓塞治疗中的应用进展[J].心血管病学进展,2014,35(6):703-706.
[15] 徐汝洪.探讨普通肝素与低分子肝素治疗次大面积肺栓塞的效果[J].海峡药学,2015,27(7):142-143.
[16] 林梓卿,吴同果,郭晓碧,等.低分子肝素治疗急性肺栓塞疗效分析[J].实用医学杂志,2008,24(4):640-642.
[17] 张庆红,王淑美,姚明.低分子肝素联合华法林治疗急性肺栓塞的临床疗效[J].实用心脑肺血管病杂志,2017,25(2):123-124.
[18] 郭方圆,侯瑞玲.低分子肝素配合尿激酶治疗急性肺血栓栓塞症的临床探讨[J].中华临床医师杂志(电子版):2016,10(11):47.
[19] 韩辉,陈英吉.不同尿激酶、低分子肝素和华法林的联合方案治疗肺栓塞的临床观察[J].世界最新医学信息文摘,2017,17(31):66,57.
[20] 席雪琴.华法林、尿激酶和低分子肝素用于肺栓塞患者治疗中的疗效[J].中西医结合心血管病电子杂志,2016,4(27):72.
[21] 刘鑫洋,白林涛,姬菩宏,等.水蛭素研究进展[J].亚太传统医药,2017,13(16):50-52.
[22] 金茜,张波,令狐金卿,等.蚓激酶的临床应用[J].职业与健康,2017,33(20):2867-2869.
[23]田志,梅霞,饶英.疏血通注射液治疗急性肺栓塞临床观察[J].中国中医急症,2014,23(7):1385-1386.
[24]宋淑清.疏血通联合抗凝药物治疗大面积肺栓塞的疗效观察[J].中西医结合心血管病电子杂志,2015,3(29):67,69.
[25]孙为勤,薛蓉.疏血通注射液联合低分子肝素、华法令治疗肺栓塞的临床观察[J].山西大同大学学报:自然科学版,2015,31(1):36-38.
[26] LüM,Wang T Y,Tian X X,et al. Interaction of anti-thrombotic and anti-inflammatory activities of commonly used traditional Chinese medicine for promoting blood circulation and removing blood stasis revealed by network pharmacology analysis[J]. Acta Pharmaceutica Sinica,2015,50(9):1135.
[27]宫金艳.丹参注射液对肺栓塞大鼠内皮素及P选择素表达水平的影响[J].血栓与止血学,2013,19(1):14-16.
[28]罗培,刘冬梅,房建斌,等.低分子肝素联合华法林及丹参多酚酸盐治疗中、低危急性肺栓塞患者的疗效[J].贵阳医学院学报,2017,42(1):97-100.
[29]赵云.低分子肝素联合丹红注射液对肺栓塞疾病的治疗价值评析[J].中国实用医药,2016,11(3):112-113.
[30]王少波.复方丹参注射液佐治急性肺栓塞疗效[J].第四军医大学学报,2005,26(z1):95.
[31]王运仓,李建科,王车江,等.川芎嗪对犬急性肺栓塞后血液流变学的影响[J].山东大学学报:医学版,2012,50(10):46-49,55.
[32]张凌.川芎嗪对急性肺血栓栓塞症大鼠细胞因子的影响及肺栓塞临床病例分析[D].武汉:华中科技大学,2006.
[33]张凌,白明,夏蕾,等.川芎嗪对急性肺血栓栓塞症大鼠ET-1、COX-2、CD54表达的影响[J].华中科技大学学报:医学版,2008,37(1):31-34.
[34]张建初,夏蕾,白明,等.实验性大鼠肺血栓栓塞症中ICAM-1、P-选择素的变化及红花注射液对其的影响[J].中国中西医结合杂志,2006,26(7):629-632.
