Clinical Efficacy And Bleeding Risk Analysis Of Rt-PA And Pro-UK Thrombolytic Therapy In Patients With Acute Pulmonary Embolism At Intermediate-high-risk

Objective:In this study,the clinical efficacy and bleeding risk differences between thrombolytic therapy and non-thrombolytic therapy within 24 hours of onset in patients with acute intermediate-high-risk pulmonary embolism were compared,as well as the clinical efficacy and bleeding risk differences between two types of thrombolytic drugs,alteplase and urokinase,in order to provide a safer and more effective treatment plan for patients with acute intermediate-high-risk pulmonary embolism risk stratification.Methods:After the review and approval of the hospital ethics committee,this study adopted a retrospective cohort study design to collect the information of patients with acute intermediate-high-risk pulmonary embolism treated in the subsidiary hospital of Jining Medical University from January 1,2018 to December 31,2022.According to the inclusion and exclusion criteria,a certain number of patients were ultimately included in the study,and the patients were divided into an experimental group（alteplase or urokinase thrombolysis treatment within24 hours after onset）and a control group（no thrombolytic treatment was given）based on whether thrombolytic therapy was performed or not,the test group was further divided into two subgroups:test group A（alteplase thrombolysis）and test group B（urokinase thrombolysis）.Collect baseline data from each group of patients and analyze if there is any statistically significant difference.Collect changes in clinical symptoms,auxiliary examination results,and adverse reactions of patients before and after treatment.The main observations are:changes in clinical symptoms such as dyspnea,wheezing,chest pain,and syncope before and after treatment;changes in Pa O₂,Sp O₂,NT-pro BNP,and Troponin-I measured before and24 hours after treatment;the PASP value of echocardiogram and the area or segmental changes of pulmonary artery filling defect displayed by CTPA were rechecked before and 7 days after treatment;Bleeding incidence after treatment.After statistical analysis of the above results,SPSS26.0 software was used for data analysis.Results:A total of 150 patients were included in the study,including85 in the experimental group（43 in experimental group A,and 42 in experimental group B）,65 in the control group.There was no statistically significant difference in baseline data between the experimental group and the control group（P>0.05）.Comparison of experimental group and control group before treatment:Blood gas analysis indexes Pa O₂（t=0.103,P=0.459）,Sp O₂（t=0.350,P=0.363）;Myocardial injury markers NT-pro BNP（t=0.243,P=0.404）,Troponin-I（t=1.123,P=0.132）;The ultrasonic indexes PASP（t=0.078,P=0.469）and RV/LV（t=0.873,P=0.192）were not statistically significant.The experimental group and the control group were compared 24 hours after treatment:Blood gas analysis indexes Pa O₂（t=7.155,P<0.001）,Sp O₂（t=9.151,P<0.001）;Myocardial injury markers NT-pro BNP（t=26.934,P<0.001）,Troponin-I（t=6.713,P<0.001）,the differences were statistically significant.The ultrasound indexes PASP（t=17.336,P<0.001）,RV/LV（t=9.490,P<0.001）of experimental group and control group were compared 7 days after treatment.The absorption range of pulmonary filling defect in CTPA was greater than25%（χ²=5.866,P=0.015）,and the difference was statistically significant.Before treatment,blood gas analysis indexes Pa O₂（t=0.052,P=0.479）and Sp O₂（t=0.100,P=0.460）in experimental group A and experimental group B;Myocardial injury markers NT-pro BNP（t=0.027,P=0.489）,Troponin-I（t=1.647,P=0.052）;The ultrasonic indexes PASP（t=0.059,P=0.477）and RV/LV（t=0.114,P=0.455）were not statistically significant.The blood gas analysis indexes Pa O₂（t=3.778,P<0.001）,Sp O₂（t=2.805,P=0.003）in experimental group A and experimental group B were compared 24 hours after treatment.Myocardial injury markers NT-pro BNP（t=6.033,P<0.001）,Troponin-I（t=5.301,P<0.001）,the differences were statistically significant.The ultrasound indexes PASP（t=1.502,P=0.068）,RV/LV（t=1.622,P=0.054）and the absorption range of pulmonary filling defect of CTPA were greater than 25%（χ²=2.097,P=0.148）,and the differences were not statistically significant.Clinical efficacy can be determined by comparing the clinical symptoms and auxiliary examination results（Pa O₂,Sp O₂,NT-pro BNP,Troponin-I,PASP,CTPA）of each group before and after treatment,to classify clinical efficacy into cured,significant,effective,and ineffective.The effective rate of clinical efficacy=（the number of recovery、significant and effective patients）/total number of patients.Through data analysis,it was found that the total effective rate of the experimental group was 87.06%,while the total effective rate of the control group was64.62%,with a statistically significant difference（χ²=11.842,P<0.001）.The total effective rate of experimental group A was 95.35%,while the total effective rate of experimental group B was 78.57%,with a statistically significant difference（χ²=5.308,P=0.021）.The incidence rate of bleeding after treatment in each group was compared.The incidence rate of bleeding in the test group was 11.76%,and that in the control group was 1.54%.The difference was statistically significant（χ²=5.668,P=0.017）.The incidence rate of bleeding in test group A was4.65%,and the incidence rate of bleeding in test group B was 19.05%.The difference was statistically significant（χ²=4.242,P=0.039）.Conclusion:1.Thrombolytic therapy can effectively correct hypoxemia,reduce myocardial damage,improve cardiac function,and recalculate embolized vessels for acute patients with moderate and high risk pulmonary embolism,especially patients with hypoxemia,so as to relieve clinical symptoms and improve prognosis.2.Thrombolysis therapy has a higher risk of bleeding than conventional anticoagulant therapy,but no fatal bleeding has occurred under close observation,but this conclusion needs to be confirmed by more research data.3.Compared with Pro-UK,rt-PA can better alleviate clinical symptoms,reduce myocardial damage and improve cardiac function in patients with acute moderate and high-risk pulmonary embolism,and rt-PA has lower bleeding risk and higher safety than Pro-UK.