Objective: To assess the efficacy and safety of thrombolytic treatment with reteplase in patients with intermediate-risk acute pulmonary embolism. Methods: Ten consecutive patients with intermediate-risk acute pulmonary embolism who received thrombolytic treatment with reteplase at Thrombosis and Vascular Medicine Center, Fuwai Hospital from March to November in 2016 were included.Vital signs, right ventricular diameter, systolic pulmonary artery pressure, and biochemical markers were assessed before and after thrombolytic therapy with reteplase, and bleeding complications were also observed during 3 months follow up. Results: (1) For the efficacy outcomes: at 48 hours after thrombolytic treatment with reteplase, echocardiography-derived diameter of right ventricular was significant reduced from (27.9±3.8) mm to (24.8±2.6) mm (P=0.03), systolic pulmonary artery pressure decreased from (63.9±21.6) mmHg(1 mmHg=0.133 kPa) to (34.4±19.8) mmHg (P=0.02). Heart rate and breathing rate were also decreased significantly (both P<0.05), blood pressure remained unchanged post therapy.Hypoxemia was quickly corrected with an significant elevation of PaO(2) and SaO(2) ((65.2±14.3) mmHg vs. (80.0±9.6) mmHg, P=0.006; (90.8±3.5)% vs. (95.2 ±1.6)%, P=0.002 respectively). PaCO(2) was also increased significantly (P<0.05). Serum NT-proBNP and cTnI were decreased significantly (both P<0.05). There was no recurrent pulmonary embolism or deep-vein thrombosis during the 3 months follow-up. (2) For the safety outcomes: a thrombolytic relevant hemoptysis (about 70 ml) occurred in 1 patient, and was controlled by PCC therapy.No other clinically relevant events were observed during thrombolytic treatment. Eight patients were followed more than 3 months, there was no major bleeding complication or death during the follow up period. Conclusion: Treatment of intermediate-risk acute pulmonary embolism with reteplase is effective and safe and there are no obvious side effects.
目的： 探讨瑞替普酶治疗中危急性肺栓塞的疗效及安全性。 方法： 连续入选2016年3至11月期间在阜外医院血栓中心住院且接受瑞替普酶溶栓治疗的中危急性肺栓塞患者10例。观察溶栓治疗后48 h患者生命体征、右心室内径、肺动脉压力以及重要血清生化标记物的变化，并随访3个月观察患者出血等不良事件的发生情况。 结果： (1)溶栓疗效评价：瑞替普酶溶栓治疗后48 h，超声心动图结果示入选患者右心室前后径平均值由基线的(27.9±3.8) mm缩小至(24.8±2.6) mm (P＝0.03)，估测肺动脉收缩压平均值由基线的(63.9±21.6) mmHg(1 mmHg＝0.133 kPa)下降至(34.4±19.8) mmHg (P＝0.02)，心率和呼吸频率均较溶栓前明显下降(P均<0.05)，血压未见明显变化，血气分析提示氧分压和血氧饱和度均明显升高[氧分压由(65.2±14.3) mmHg升高至(80.0±9.6) mmHg, P＝0.006；血氧饱和度由(90.8±3.5)%升高至(95.2 ±1.6)%, P＝0.002]，二氧化碳分压明显升高(P<0.05)，血清N末端B型利钠肽原、心肌肌钙蛋白I均明显下降(P均<0.05)。随访3个月无患者发生肺栓塞及下肢深静脉血栓形成复发。(2)溶栓安全性评价：溶栓治疗即刻至7 d内，仅有1例患者在瑞替普酶溶栓治疗结束后即刻发生咯血(量约70 ml)，给予人凝血酶原复合物300 U静脉泵入后停止。无其他不良事件发生。有8例患者完成了溶栓治疗即刻至3个月的随访，均未发生大出血及死亡事件。 结论： 瑞替普酶溶栓治疗中危急性肺栓塞患者近期疗效确切，且安全性良好。.
Keywords: Pulmonary embolism; Reteplase; Treatment outcome.