Effectof Retineptidase Thrombolysis On Recurrence Rate And Pulmonary Hypertension In Patients With Moderate To High Risk Pulmonary Embolism

Objective:To explore the effect of retinyl thrombolysis on the recurrence rate of pulmonary embolism and pulmonary hypertension in patients with high-risk pulmonary embolism,and to choose the best treatment for APTE patients.Methods:1.Select 50 patients with moderate to high risk APTE who were hospitalized in Taian Central Hospital from May 2015 to May 2017 as subjects.All patients were eligible for acute pulmonary thromboembolism in the middle and high risk groups.There were 35 patients in the study group(using reteplase thrombolytic + anticoagulant therapy group)and 15 patients in the control group(single anticoagulation group).The effects of the two treatments on the clinical symptoms of the subjects and the improvement of pulmonary hypertension and the recurrence rate after 1 year of follow-up were compared2.Study group: Apply reteplase 18 mg,dissolved in 10 ml normal saline,slowly intravenous bolus injection,the time is more than 2 minutes,30 minutes after the addition of reteplase 18 mg intravenous bolus.Immediately after the first thrombolysis treatment,low molecular weight heparin sodium was given anticoagulation,subcutaneous injection of5000 IU/time,q12H;overlapping warfarin orally,initial dose was 3 mg/d,adjusted according to international normalized ratio(INR)The dose was maintained between 2-3and the anticoagulant treatment time was 6 months.Control group: Thrombolytic therapy was not given.Direct administration of low molecular weight heparin sodium anticoagulation,subcutaneous injection of 5000IU/time,q12H;overlapping warfarin oral,initial dose of 3mg / d,according to the international normalized ratio(INR)to adjust the dose,maintain INR in 2-3 The duration of anticoagulant therapy was maintained for 6months.3.Observed the incidence of bleeding complications in the two groups.Subcutaneous hemorrhage,bleeding of the gums and hemorrhage at the puncture site were mild hemorrhage;intracranial hemorrhage or hemorrhage greater than 1000 ml was severe hemorrhage;mild hemorrhage and severe bleeding Intermittent hemodynamic bleeding is defined as moderate bleeding.4.After the hospital was discharged,the patients were followed up for 1 year.The recurrence rate of the patients was observed and the changes of pulmonary artery pressure were reviewed.5.SPSS19.0 statistical software was used for data analysis.P<0.01 indicated that the difference was statistically significant.P<0.05 indicated that the difference was statistically significant.Results:1.There was no significant difference(P>0.05)between the study group and the control group before treatment,including gender,age,blood pressure,heart rate,pulse oxygen saturation,oxygen partial pressure and pulmonary artery pressure(P>0.05).2.The therapeutic effect of the study group and the control group was compared.The pulmonary artery pressure was decreased by 48-72 hours after treatment.The mean pulmonary artery pressure before treatment was 59.29±18.44 mm Hg,and 36.83±15.18 mm Hg after treatment.There was a significant difference between the two groups(P=0.00).The mean pulmonary artery pressure before treatment was 59.93±8.63 mm Hg,and51.27±15.52 mm Hg after thrombolysis.There was a significant difference between the two groups(P=0.011).The effective rate of treatment in the study group was 85.7%,and the effective rate in the control group was 40%.There was a significant difference between the two groups(P<0.05).3.After treatment for 1 to 3 years,there were recurrence events in both groups.There were 1 case in the study group(recurrence after 3 years)and 4 cases in the control group(one of them had undergone thoracotomy and the other 3 cases of pulmonary artery).There were still thrombosis,two cases did not agree with surgery,and one case was not treated with renal insufficiency.The difference in recurrence rate between the two groups was statistically significant(P<0.05).Conclusions:1.The application of reteplase thrombolytic therapy combined with anticoagulation in patients with high-risk acute pulmonary embolism can significantly reduce pulmonary hypertension,and the clinical effect is good.2.The application of reteplase thrombolysis can significantly reduce the recurrence rate of patients with high-risk pulmonary embolism.