Streptokinase and heparin versus heparin alone in massive pulmonary embolism: A randomized controlled trial
Streptokinase and heparin versus heparin alone in massive pulmonary embolism: A randomized controlled trial
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链激酶联合肝素与单独使用肝素治疗大面积肺栓塞：一项随机对照试验
DOI：
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发表时间：
2005
影响因子：
4
通讯作者：
E. Rosas
中科院分区：
文献类型：
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作者：
C. Jerjes;A. Ramírez;María García;R. Arriaga;S. Valencia;A. Rosado;J. A. Pierzo;E. Rosas
为了验证溶栓治疗大面积肺栓塞的疗效，我们进行了一项前瞻性随机对照试验。8例患者随机接受1小时内通过外周静脉注射1，500，000 IU链激酶，随后接受肝素或仅接受肝素。所有患者均具有深静脉血栓形成（DVT）的主要风险因素，并被认为具有肺栓塞（PE）的高度临床怀疑。基线时，所有患者的全身动脉低血压、肺动脉高压和右心室功能障碍程度相似。两组的心源性休克发作时间相当（链激酶组为2.25 ±0.5小时，肝素组为1.75 ±0.96小时）。随机分配至链激酶组的4名患者在治疗后1小时内病情好转，存活，随访2年无肺动脉高压。仅接受肝素治疗的所有4例患者均在到达急诊室后1 - 3小时死亡（p=0.02）。溶栓治疗后，通过高概率V/Q肺扫描和证实的DVT，链激酶组的PE诊断持续存在。在肝素组的3名患者中进行的尸检研究显示大面积肺栓塞和右心室心肌梗死，无明显冠状动脉阻塞。结果表明，溶栓治疗可降低大面积急性肺栓塞的死亡率。
To test the efficacy of thrombolytic therapy in massive pulmonary embolism, we conducted a prospective randomized controlled trial. Eight patients were randomized to receive either 1,500,000 IU of streptokinase in 1 hour through a peripheral vein followed by heparin or heparin alone. All patients had major risk factors for deep vein thrombosis (DVT) and were considered to have high clinical suspicion for pulmonary embolism (PE). At baseline all patients had a similar degree of systemic arterial hypotension, pulmonary arterial hypertension, and right ventricular dysfunction. The time of onset of cardiogenic shock in both groups was comparable (2.25 ±0.5 hours in the streptokinase group and 1.75 ±0.96 hours in the heparin group). The four patients who were randomized to streptokinase improved in the first hour after treatment, survived, and in 2 years of follow-up are without pulmonary arterial hypertension. All four patients treated with heparin alone died from 1 to 3 hours after arrival at the emergency room (p=0.02). Post-thrombolytic therapy the diagnosis of PE was sustained in the streptokinase group by high probability V/Q lung scans and proven DVT. A necropsy study performed in three patients in the heparin group showed massive pulmonary embolism and right ventricular myocardial infarction, without significant coronary arterial obstruction. The results indicate that thrombolytic therapy reduces the mortality rate of massive acute pulmonary embolism.