【作者】 李军；

【导师】 王在义；

【作者基本信息】 新疆医科大学 ， 内科学， 2012， 硕士

【摘要】 目的：探讨D-二聚体动态变化对急性肺栓塞溶栓疗效的判断。方法：纳入对象为在2010.01～2011.10入住新疆医科大学第一附属医院呼吸二科的62例根据2008年ESC公布的急性PE的诊断和治疗指南诊断为高危组和中危组的急性PE接受溶栓治疗患者。记录所有患者溶栓前及溶栓后24小时内每4小时，溶栓10天时血浆D-二聚体浓度，溶栓前及溶栓后10天时的Borg呼吸困难评分；62例患者入院时及溶栓10天时进行CTPA检查，比较两次CTPA血栓变化情况.10天后根据CTPA肺栓塞是否消溶分为全通组和未全通组。结果：1）栓塞肺段全通组（29例）：血浆D-二聚体于溶栓后4～8小时达高峰，溶栓后4～8小时血浆D-二聚体值异常升高，达到溶栓前2.7倍，随后进行性下降，溶栓后10d回落至接近溶栓前水平（t=1.306，P=0.202），而未全通组（32例）则较全通组达峰时间明显延迟，其峰值达到溶栓前2.3倍，随后进行性下降，溶栓后24小时仍高于溶栓前水平（t=8.2, P＜0.01），至溶栓10d两组与溶栓前比较均明显降低；2）溶栓10天后，总体治疗效果评价：治愈29人（占总人数46.7%），显效19人（占总人数30.7%），好转13人（占总人数21%），死亡1（占总人数1.6%）人，总有效率98.4%；3）溶栓后D-二聚体达峰浓度与溶栓前浓度差值与溶栓减少的肺段数目之间有一定相关性（rs=0.594，P＜0.05），与患者呼吸困难改善程度也有一定相关性（rs=0.301，P=0.019）。结论：D-二聚体动态监测对急行肺栓塞溶栓治疗效果判断有重要指导价值，其动态变化幅度与血栓溶解程度具有相关性，可以大致根据其变化幅度判断血栓溶解程度。更多还原

【Abstract】 Objective: To investigate the judgment of the effect of thrombolytic therapy on acutepulmonary embolism through the dynamic changes of D-dimer in plasma. Methods:62patients were admitted in the No.2Department of Respiratory in the first affiliated hospitalof Xinjiang Medical University from2010.01to2011.10for acute pulmonary embolism anddiagnosed as high or moderate risk group according to guidelines on the diagnosis andmanagement of acute pulmonary embolism of the European Society of Cardiology(ESC)in2008. They had been received thrombolytic therapy and been included in this study. Thevalues of plasma D-dimer concentration in8phases(before and after thrombolysis, per4hours in day1, day10)were recorded. Before and10days later of thrombolytic therapy,Borg dyspnea scores were evaluated and CTPA was performed. Then, the results of CTPAwere compared. Results:1) The D-dimer concertration in plasma reached the peak at4-8hof administration, as2.7fold as before administration, then returned to the level of beforeadministration at24h in the complete recanalization group (t=1.306, P=0.202); while thepartial recanalization reached the peak delayed, as2.3fold as before the treatment, anddecreased later, but remained higher than pre-administration.10days later, two groups werehigher than before administration (t=8.2, P＜0.01).2)The overall evaluation of the effect oftreatment at10days later:29cases were cured (46.7%),19cases (30.7%) were markedlyimproved, improved in13cases (21%),1case was dead for vaginal bleeding, the totalefficiency rate was98.4%.3) There is a linear correlation between the D-dimerconcertration difference (before and the peak after administration) and the number ofreduced embolized lung segment (rs=0.594, P＜0.05), between the D-dimer concertrationdifference and the improvement of dyspnea (rs=0.301, P=0.019). Conclusion: Dynamic monitor of the plasma D-dimer is a reliable method of judging the efficacy of thethrombolytic treatment. Its dynamic changes in amplitude are associated with the degree ofthrombus dissolving. We can assess the degree of thrombus dissolving according to thevariation amplitude of D-dimer in plasma.更多还原