Clinical Analysis Of Thrombolytic Therapy With Alteplase In Patients With Acute High-risk Pulmonary Thrombosis

Objective:To analyze the clinical characteristics and risk factors of acute high-risk pulmonary thromboembolism,and to explore the efficacy and safety of alteplase thrombolytic therapy in order to improve the diagnosis rate,reduce mortality and morbidity.Provide experience in the treatment of pulmonary thromboembolism.Methods: A retrospective analysis methods for the collection of Ningxia Medical University General Hospital from January 2011-December 2015 General Information 63 hospitalized patients with acute pulmonary thromboembolism in high-risk patients,hospital stay,risk factors,clinical symptoms and thrombolysis Before and after the auxiliary examination results and post-thrombolytic complications,outcome and other clinical data,statistics of the frequency of clinical data,and the use of statistical methods before and after thrombolytic therapy indicators were compared.Results: 26 males and 37 females,male to female ratio: 1: 1.42,with an average age of(61.06 ± 12.76)years,the average length of stay(19.76 ± 10.13)days.2.Risk factors include infection,lower extremity venous thrombosis,age(> 60 years),hypertension,surgery,coronary heart disease,COPD,diabetes,fractures,atrial fibrillation,cancer and so on.3.Common clinical symptoms of dyspnea,hypotension,syncope,pleural effusion,hemoptysis,chest pain and other symptoms,of which 96.8% of patients with dyspnea,84.13% of low blood pressure,syncope 71.43%.In addition,12 patients(19.05%)had dyspnea,hemoptysis,and chest pain.4.Auxiliary examination results:(1)arterial blood gas analysis: oxygen partial pressure <60mmHg patients in 40 cases,82.53% of patients with carbon dioxide partial pressure less than 35 mm Hg.(2)D-dimer: the mean level of thrombolysis was(9.28 ± 8.12)mg/L,the mean value(26.24 ± 21.28)mg/L within 24 hours after thrombolysis,Thrombolysis72 hours after the D-dimer level down the normal range,three measurements were significantly different(P <0.05).(3)ECG: characteristic changes in SIQⅢTⅢ changes in 39 patients,sinus tachycardia in 61 cases,36 cases of pulmonary P wave and so on.(4)echocardiography: tricuspid regurgitation in 49 cases,39 cases of pulmonary hypertension,right ventricular enlargement in 37 cases.(4)CT pulmonary artery imaging(CTPA): patients with CTPA showed pulmonary artery and its branch filling defect signs which embolized pulmonary artery trunk in 3 cases(4.76%),right pulmonary artery trunk 47 cases,38 cases of left pulmonary artery trunk,right lung: Cases,26 cases of middle lobe,35 cases of lower lobe,left lung: 30 cases of upper lobe,37 cases of lower lobe.(P <0.05).The heart rate and respiratory rate were decreased(P <0.05),and the pulse pressure was increased(P <0.05),and the heart rate and respiratory rate were decreased(P <0.05)(P <0.001).Cardiac ultrasonography showed a decrease in right ventricular anteroposterior,right ventricular anteroposterior diameter,pulmonary artery diameter and pulmonary artery pressure(P <0.05).5.Thrombolytic therapy after the outcome: thrombolytic total effective rate of 82.54%,mortality rate of 9.52%.6.Complications after thrombolysis,the incidence of 33.33%,intracranial hemorrhage in 1 case(1.59%).Conclusion: The incidence of acute high risk PTE patients is positively correlated with age,lower limb venous thrombosis,infection,cardiovascular disease,trauma,surgery and diabetes are the main risk factors of its incidence.D-dimer,electrocardiogram,blood gas analysis,heart color Doppler ultrasound,lower extremity color Doppler ultrasound can be used as a newly diagnosed auxiliary examination method,CTPA as a diagnosis of pulmonary embolism clinical first-line diagnostic means.Acute high-risk PTE patients,timely diagnosis and treatment is the key to reduce mortality,including thrombolytic therapy is an important way to relieve pulmonary artery obstruction in a timely manner,given patients with alteplase thrombolytic therapy,patients with low blood pressure,difficulty breathing,etc.And theincidence of severe complication after thrombolysis was low,which could be used as acute high-risk pulmonary thromboembolism.Conclusion: The pulmonary arterial diameter,D-dimer and so on were significantly changed before and after thrombolysis.The first-line treatment of drugs.