The Analysis Of Different Dose Rt-PA Therapy For Acute Pulmonary Embolism

Objective:Through collecting the patients with acute pulmonary embolism in Tianjin medical university general hospital, we get the information about clinical manifestations, risk factors and the differences after thrombolysis.All patients were treated with rt-PA. we also want to know the efficacy of thrombolytic therapy and the risk of bleeding with different dose rt-PA. The analysis of the situation of50mg rt-PA thrombolysis failure will be helpful to guide the clinical.Hoping our work could provide reference for the clinical basis.Method:Collecting nearly10years of TianJin medical university general hospital respiratory medicine application of rt-PA thrombolysis therapy in patients with acute pulmonary embolism,41cases of50mg rt-PA primary treatment of30cases,100mg rt-PA primary treatment of11cases, including5cases of50mg rt-PA treatment failed.we analyze clinical manifestations and risk factors in all patients.According to different initial doses of rt-PA into50mg rt-PA treatment group,100mg rt-PA treatment group, we analyze the change of vital signs and related indicators in two groups before and after thrombolysis.the efficacy of thrombolytic therapy and the risk of bleeding also were valued.Application SPSS19.0statistical software processing data, P<0.05for the difference was statistically significant.Result:(1)This study collected41patients with acute pulmonary embolism,2patients died, the mortality was4.88%.11patients with100mg rt-PA group,9cases of male and female in2cases, mean age (52.18±13.51) years of age,50mg rt-PA group of30cases of patients,14cases of male, female16cases, the average (58.73±13.00) years of age, there are5cases of50mg rt-PA group thrombolytic therapy failure;Two groups of patients with gender, age, breathing rate, heart rate and systolic blood pressure,there was no statistically significant difference; two groups of patients with platelet count and D-Dimer, there was no statistically significant difference;And two groups hospitalization time100mg rt-PA group shorter,the difference was statistically significant (P=0.029).(2)Two groups of patients with the most common clinical symptoms was dyspnea (87.80%), followed by chest pain, two groups of patients with the most common risk factors was DVT (34.15%), followed by the causative factor has no obvious, moreover for surgery, active history of tumor.(3)The total hemorrhage rate was36.59%in41patients with acute pulmonary embolism, including cerebral hemorrhage in1case,1case of gastrointestinal bleeding, no patients died; as a result of bleeding100mg rt-PA group total hemorrhage rate was63.63%higher than50mg rt-PA group19.52%, but there was no statistical difference in the two groups.Two groups have no1case reached the degree of cure,10cases thearepy failure of(including death) and the deterioration of the patients including100mg rt-PA group in2cases,50mg rt-PA group8cases, there was no statistically significant difference in curative effect.(4)20patients with acute pulmonary embolism were monitoring D-dimer respectively before thrombolysis, thrombolysis after and before hospital discharge, after thrombolysis D-dimer appear obvious peak, before hospital discharge D-dimer returned to normal.(5)In50mg rt-PA group and100mg rt-PA breathing rate, heart rate and arterial systolic blood pressure after thrombolysis in each time period have different degrees of improvement, but at the same time the comparison of differences between the two groups has no statistical significance.Two groups of PO2, PCO2, P (A-a) O2, D-dimer improve earlier after thrombolysis, the difference was statistically significant (P<0.05).At the same time comparing differences between two groups has no statistical significance.(6)5patients of secondary thrombolysis, accounting for16.13%of the50MGRT-PA group of patients (5/30), including four female1male, with an average age of53.6years, age range (43-76).4cases (80%) appeared sudden shortness of breath, syncope in2cases,2cases of chest pain.Four of them (80%) patients had history of lower extremity deep vein thrombosis,1patients had active cancer.After secondary thrombolysis0cases with hemorrhage,2cases of patients suffered from bleeding puncture, no bleeding in patients with the rest.(7) Mostly APE patients received thrombolysis in2003to2004, accounts for (92.68%), especially in2003、2004. The thrombolysis treatment of acute pulmonary embolism significant decline in recent years.Conclusions:(1)All patients with acute pulmonary embolism who need thromolytic therapy, the most common clinical symptoms was breathing difficulties, the most common risk factor was DVT history.(2)D-dimer rise after thrombolysis, form a peak, and then return to normal, D-dimer changes after thrombolysis, helps to evaluating the effect of thrombolysis in patients with pulmonary embolism, needs to be studied further.(3)In100mg,50mg rt-PA group,blood gas analysis index before and after rt-PA after thrombolysis and vital signs and so on all have different degrees of improvement, two groups of bleeding risk and curative effect is similar.50mgrt-PA can be consider to treat APE.(4)5patients with acute pulmonary embolism were thrombolysis failure using50mgrt-PA. When we use50mgrt-PA therapy APE,the thrombolysis failure risk should be noticed, especially patients with DVT.(5)Thrombolysis treatment in patients with acute pulmonary embolism is on the decline, the peak appeared in the2003years or so.