抗凝与溶栓治疗肺癌并发肺栓塞的疗效比较
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摘要
目的:比较抗凝与溶栓治疗肺癌并发肺栓塞的临床疗效。方法:回顾性选取2013年1月至2018年8月湖南省肿瘤医院收治的肺癌并发肺栓塞患者91例,根据实际治疗方法的不同分为A组(45例)和B组(46例)。A组患者采用抗凝治疗,B组患者采用溶栓治疗。观察两组患者的呼吸困难缓解情况、临床检查结果、临床疗效及各项临床指标水平[心率、肺动脉收缩压(PASP)、血氧分压(PaO_2)及血二氧化碳分压(PaCO_2)]。结果:(1)所有患者治疗前均出现了呼吸困难;治疗后,A组患者呼吸困难缓解44例,1例死亡;B组患者呼吸困难缓解45例,死亡1例。(2)治疗前,A组心动过速患者43例,B组45例。治疗后,A组患者心电图心率恢复正常42例,死亡1例;B组患者心电图心率恢复正常44例,死亡1例。(3)治疗前,所有患者肺动脉CT血管造影结果均为阳性。治疗后,A组44例患者好转,1例死亡;B组45患者好转,1例死亡。(4)治疗前,A组32例、B组35例患者行下肢静脉B超检查,结果均为阳性。治疗后,A组31例患者下肢静脉B超检查结果无变化,1例死亡;B组34例患者无变化,1例死亡。(5)治疗前,A组患者PaO_2水平降低29例,PaCO_2水平降低13例;B组患者PaO_2降低27例,PaCO_2降低10例。治疗后,A组血气分析结果正常患者41例,死亡1例;B组血气分析结果正常患者37例,死亡1例。(6)A、B组患者的总有效率为97.8%(44/45)、97.8%(45/46),差异无统计学意义(P>0.05)。(7)治疗后,A组患者心率、PaO_2及PaCO_2水平明显优于治疗前,B组患者心率、PASP、PaO_2及PaCO_2水平明显优于治疗前,差异均有统计学意义(P<0.05);两组患者治疗前后心率、PASP、PaO_2及PaCO_2水平的差异均无统计学意义(P>0.05)。结论:对于肺癌合并肺栓塞患者,抗凝、溶栓治疗的疗效相近。但对于无肺动脉高压的小块肺栓塞患者,溶栓治疗的风险性较大,可将抗凝治疗作为首选。
OBJECTIVE: To compare the clinical efficacy of anticoagulation and thrombolysis in treatment of lung cancer complicated with pulmonary embolism. METHODS: Totally 91 patients with lung cancer complicated with pulmonary embolism admitted into Hunan Cancer Hospital from Jan. 2013 to Aug. 2018 were retrospectively extracted to be divided into the group A(n=45) and the group B(n=46) via different treatment methods. Patients in the group A received anticoagulation, and the group B was given thrombolysis. The relief of dyspnea, clinical examination results, clinical efficacy and various clinical indicators [heart rate, pulmonary systolic pressure(PASP), blood oxygen partial pressure(PaO_2) and blood carbon dioxide partial pressure(PaCO_2)] of two groups were observed. RESULTS:(1) All patients developed dyspnea before treatment; after treatment, the group A had 44 cases of dyspnea and 1 case of death; the group B had 45 cases of dyspnea and 1 case of death.(2) Before treatment, 43 patients with tachycardia in group A and 45 patients in group B. After treatment, the electrocardiogram(EGG) heart rate returned to the normal state in 42 patients in group A, and 1 patient died. In group B, the ECG heart rate returned to the normal state in 44 patients, and 1 patient died.(3) All patients had positive CT pulmonary angiography before treatment. After treatment, 44 patients in group A improved and 1 patient died; 45 patients in group B improved and 1 patient died.(4) Before treatment, 32 patients in group A and 35 patients in group B underwent B-ultrasound examination of lower limbs, all of which were positive. After treatment, 31 patients in group A had no change in the results of B-ultrasound examination of the lower limbs, and 1 patient died; 34 patients in group B had no change, and 1 patient died.(5) Before treatment, the PaO_2 level was decreased in 29 patients and the PaCO_2 level was decreased in 13 patients. In group B, PaO_2 was decreased in 27 cases and PaCO_2 was decreased in 10 cases. After treatment, the blood gas analysis results of group A were normal in 41 patients, and 1 patient died; in group B, the blood gas analysis results were normal in 37 patients, and 1 patient died.(6) The total effective rate of patients in group A and group B was 97.8%(44/45) and 97.8%(45/46), with no statistically significant difference(P>0.05).(7) After treatment, the heart rate, PaO_2 and blood carbon dioxide partial pressure of group A were significantly better than those before treatment, the heart rate, PASP, PaO_2 and PaCO_2 levels in group B were significantly better than before treatment, with statistically significant difference(P<0.05). There were no significant differences in heart rate, PASP, PaO_2 and PaCO_2 levels between the two groups before and after treatment(P>0.05). CONCLUSIONS: For patients with lung cancer complicated with pulmonary embolism, anticoagulation and thrombolysis have the similar efficacy. However, for patients with small pulmonary embolism without pulmonary hypertension, thrombolysis has a greater risk, and anticoagulation can be the first choice.
OBJECTIVE: To compare the clinical efficacy of anticoagulation and thrombolysis in treatment of lung cancer complicated with pulmonary embolism. METHODS: Totally 91 patients with lung cancer complicated with pulmonary embolism admitted into Hunan Cancer Hospital from Jan. 2013 to Aug. 2018 were retrospectively extracted to be divided into the group A(n=45) and the group B(n=46) via different treatment methods. Patients in the group A received anticoagulation, and the group B was given thrombolysis. The relief of dyspnea, clinical examination results, clinical efficacy and various clinical indicators [heart rate, pulmonary systolic pressure(PASP), blood oxygen partial pressure(PaO_2) and blood carbon dioxide partial pressure(PaCO_2)] of two groups were observed. RESULTS:(1) All patients developed dyspnea before treatment; after treatment, the group A had 44 cases of dyspnea and 1 case of death; the group B had 45 cases of dyspnea and 1 case of death.(2) Before treatment, 43 patients with tachycardia in group A and 45 patients in group B. After treatment, the electrocardiogram(EGG) heart rate returned to the normal state in 42 patients in group A, and 1 patient died. In group B, the ECG heart rate returned to the normal state in 44 patients, and 1 patient died.(3) All patients had positive CT pulmonary angiography before treatment. After treatment, 44 patients in group A improved and 1 patient died; 45 patients in group B improved and 1 patient died.(4) Before treatment, 32 patients in group A and 35 patients in group B underwent B-ultrasound examination of lower limbs, all of which were positive. After treatment, 31 patients in group A had no change in the results of B-ultrasound examination of the lower limbs, and 1 patient died; 34 patients in group B had no change, and 1 patient died.(5) Before treatment, the PaO_2 level was decreased in 29 patients and the PaCO_2 level was decreased in 13 patients. In group B, PaO_2 was decreased in 27 cases and PaCO_2 was decreased in 10 cases. After treatment, the blood gas analysis results of group A were normal in 41 patients, and 1 patient died; in group B, the blood gas analysis results were normal in 37 patients, and 1 patient died.(6) The total effective rate of patients in group A and group B was 97.8%(44/45) and 97.8%(45/46), with no statistically significant difference(P>0.05).(7) After treatment, the heart rate, PaO_2 and blood carbon dioxide partial pressure of group A were significantly better than those before treatment, the heart rate, PASP, PaO_2 and PaCO_2 levels in group B were significantly better than before treatment, with statistically significant difference(P<0.05). There were no significant differences in heart rate, PASP, PaO_2 and PaCO_2 levels between the two groups before and after treatment(P>0.05). CONCLUSIONS: For patients with lung cancer complicated with pulmonary embolism, anticoagulation and thrombolysis have the similar efficacy. However, for patients with small pulmonary embolism without pulmonary hypertension, thrombolysis has a greater risk, and anticoagulation can be the first choice.
引文
[1] 唐域,滕秀志.肺癌患者并发静脉血栓与肺栓塞的危险因素分析[J].临床肺科杂志,2014,19(3):453-455.
[2] 刘金平.肺血栓栓塞症的诊断与治疗指南[J].世界最新医学信息文摘:连续型电子期刊,2013,13(35):248-249.
[3] 中华医学会心血管病学分会肺血管病学组,中国医师协会心血管内科医师分会.急性肺血栓栓塞症诊断治疗中国专家共识[J].中华内科杂志,2010,49(1):74-81.
[4] Konstantinides SV,Torbicki A,Agnelli G,et al.Corrigendum to:2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism[J].Eur Heart J,2014,36(39):2642.
[5] 常智.23例肺癌合并肺栓塞的回顾性分析[J].贵阳中医学院学报,2012,34(4):27-29.
[6] 逯林欣,弓清梅,杨美霞.肺栓塞82例临床分析[J].中西医结合心脑血管病杂志,2011,9(12):1518-1519.
[7] 李伟,许波宁,朱美君.急性肺栓塞56例临床特点分析[J].中国冶金工业医学杂志,2008,25(1):45-46.
[8] Jaff MR,McMurtry MS,Archer SL,et al.Management of massive and submassive pulmonary embolism,iliofemoral deep vein thrombosis,and chronic thromboembolic pulmonary hypertension:a seientific statement form the American Heart Association[J].Circulation,2011,123(16):1788-1830.
[9] 刘歆.310例肺栓塞临床预后和生存分析研究[D].福州:福建医科大学,2015.
[10] 慈晓,赵仁国,张鸣华,等.溶栓与抗凝治疗对肺栓塞远期效果评价[J].福建医药杂志,2006,28(3):17-18.
[11] 郭丽,侯娟,刘宇,等.埃克替尼与华法林药物相互作用1例[J].中国新药与临床杂志,2014,33(7):551-552.
[12] 赵梦华,宋文奇.中危肺栓塞患者的溶栓治疗[J].血栓与止血学,2015,21(1):54-56.
[13] 罗细红,吴尚洁.次大面积肺栓塞患者应用溶栓联合抗凝治疗及单纯抗凝治疗的疗效对比分析[J].河北医学,2017,23(8):1348-1351.
[14] 米玉红,梁颖,陆艳辉,等.中危急性肺栓塞患者溶栓治疗的安全性及有效性[J].中华急诊医学杂志,2013,22(2):158-163.
[15] 胡彬.阿替普酶与尿激酶溶栓治疗急性心肌梗死的疗效对比分析[J].实用药物与临床,2013,16(10):960-962.
[2] 刘金平.肺血栓栓塞症的诊断与治疗指南[J].世界最新医学信息文摘:连续型电子期刊,2013,13(35):248-249.
[3] 中华医学会心血管病学分会肺血管病学组,中国医师协会心血管内科医师分会.急性肺血栓栓塞症诊断治疗中国专家共识[J].中华内科杂志,2010,49(1):74-81.
[4] Konstantinides SV,Torbicki A,Agnelli G,et al.Corrigendum to:2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism[J].Eur Heart J,2014,36(39):2642.
[5] 常智.23例肺癌合并肺栓塞的回顾性分析[J].贵阳中医学院学报,2012,34(4):27-29.
[6] 逯林欣,弓清梅,杨美霞.肺栓塞82例临床分析[J].中西医结合心脑血管病杂志,2011,9(12):1518-1519.
[7] 李伟,许波宁,朱美君.急性肺栓塞56例临床特点分析[J].中国冶金工业医学杂志,2008,25(1):45-46.
[8] Jaff MR,McMurtry MS,Archer SL,et al.Management of massive and submassive pulmonary embolism,iliofemoral deep vein thrombosis,and chronic thromboembolic pulmonary hypertension:a seientific statement form the American Heart Association[J].Circulation,2011,123(16):1788-1830.
[9] 刘歆.310例肺栓塞临床预后和生存分析研究[D].福州:福建医科大学,2015.
[10] 慈晓,赵仁国,张鸣华,等.溶栓与抗凝治疗对肺栓塞远期效果评价[J].福建医药杂志,2006,28(3):17-18.
[11] 郭丽,侯娟,刘宇,等.埃克替尼与华法林药物相互作用1例[J].中国新药与临床杂志,2014,33(7):551-552.
[12] 赵梦华,宋文奇.中危肺栓塞患者的溶栓治疗[J].血栓与止血学,2015,21(1):54-56.
[13] 罗细红,吴尚洁.次大面积肺栓塞患者应用溶栓联合抗凝治疗及单纯抗凝治疗的疗效对比分析[J].河北医学,2017,23(8):1348-1351.
[14] 米玉红,梁颖,陆艳辉,等.中危急性肺栓塞患者溶栓治疗的安全性及有效性[J].中华急诊医学杂志,2013,22(2):158-163.
[15] 胡彬.阿替普酶与尿激酶溶栓治疗急性心肌梗死的疗效对比分析[J].实用药物与临床,2013,16(10):960-962.