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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (01) : 42 -48. doi: 10.3877/cma.j.issn.1674-6902.2026.01.007

论著

rt-PA剂量对中高危急性肺栓塞患者超声辅助置管溶栓期间肺动脉压和出血风险的影响
常人元1, 雷涛2, 王彤1, 陈宇3, 李志梅1, 高欣1, 周楠4, 曹磊5, 董艳芳6, 刘静静1,†()   
  1. 1719000　榆林，榆林市第一医院药学部
    2719000　榆林，榆林市第一医院超声诊断科
    3719000　榆林，榆林市第一医院病案室
    4710068　西安，陕西省人民医院药学部
    5719000　榆林，榆林市第一医院急诊科
    6719000　榆林，榆林市第一医院呼吸与危重症医学科
  • 收稿日期:2025-07-18 出版日期:2026-02-25
  • 通信作者: 刘静静
  • 基金资助:
    陕西省自然科学基金项目(2023-JC-YB-639)

Effect of rt-PA dose on pulmonary artery pressure and bleeding volume during ultrasound-assisted catheter thrombolysis in patients with moderate- to high-risk acute pulmonary embolism

Renyuan Chang1, Tao Lei2, Tong Wang1, Yu Chen3, Zhimei Li1, Xin Gao1, Nan Zhou4, Lei Cao5, Yanfang Dong6, Jingjing Liu1,†()   

  1. 1Department of Pharmacy, The First Hospital of Yulin, Yulin 719000, China
    2Department of Ultrasound, The First Hospital of Yulin, Yulin 719000, China
    3Medical Records Department, The First Hospital of Yulin, Yulin 719000, China
    4Department of Pharmacy, Shaanxi Provincial People′s Hospital, Xian 710068, China
    5Department of Emergency, The First Hospital of Yulin, Yulin 719000, China
    6Department of Respiratory and Critical Care Medicine, The First Hospital of Yulin, Yulin 719000, China
  • Received:2025-07-18 Published:2026-02-25
  • Corresponding author: Jingjing Liu
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引用本文：

常人元, 雷涛, 王彤, 陈宇, 李志梅, 高欣, 周楠, 曹磊, 董艳芳, 刘静静. rt-PA剂量对中高危急性肺栓塞患者超声辅助置管溶栓期间肺动脉压和出血风险的影响[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(01): 42-48.

Renyuan Chang, Tao Lei, Tong Wang, Yu Chen, Zhimei Li, Xin Gao, Nan Zhou, Lei Cao, Yanfang Dong, Jingjing Liu. Effect of rt-PA dose on pulmonary artery pressure and bleeding volume during ultrasound-assisted catheter thrombolysis in patients with moderate- to high-risk acute pulmonary embolism[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(01): 42-48.

目的

分析重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator, rt-PA)剂量对中高危急性肺栓塞(pulmonary embolism, PE)患者经超声辅助导管导向溶栓(ultrasound-assisted catheter-directed thrombolysis, UACDT)期间肺动脉压力及出血风险的影响。

方法

回顾性纳入2020年2月至2024年12月我院收治的经UACDT治疗中高危急性PE患者42例，根据累计rt-PA剂量分组，rt-PA≤24 mg 21例为对照组，rt-PA>24 mg 21例为观察组。记录治疗期间累计rt-PA剂量、收缩期肺动脉压(systolic pulmonary artery pressure, sPAP)变化及术后并发症，比较两组右心室压力负荷、血流动力学参数sPAP、平均肺动脉压(mean pulmonary artery pressure, mPAP)及舒张期肺动脉压(diastolic pulmonary artery pressure, dPAP)，分析累计rt-PA剂量与术后出血风险关系。

结果

UACDT平均治疗时间(61.89±28.76)h，累计rt-PA(43.28±30.03)mg。sPAP随累计rt-PA增加呈下降趋势(F＝12.451，P<0.001)。对照组治疗后右心负荷正常10例(47.62%)、轻度9例(42.86%)、中度1例(4.76%)、重度1例(4.76%)(P<0.001)；观察组治疗后右心负荷正常14例(66.67%)、轻度7例(33.33%)，无中度和重度患者(P<0.001)。两组治疗后sPAP、mPAP及dPAP较治疗前降低(P<0.05)。治疗后观察组sPAP(43.10±4.90) mmHg、mPAP(23.10±3.20 )mmHg和dPAP(17.60±2.70 )mmHg低于对照组sPAP(49.80±5.40) mmHg、mPAP(26.70±3.80)mmHg和dPAP(20.70±3.10)mmHg(P<0.05)。观察组治疗后肺血管阻力(201.20±28.80) dyn·s·cm－5低于对照组PVR(265.40±35.10)dyn·s·cm－5(P<0.001)。术后重症监护室平均住院时间(4.89±3.14)d，总住院时间(8.01±5.38)d。观察组血栓溶解完全18例(85.71%)高于对照组10例(48.00%)(χ2＝6.886，P＝0.032)；平均血栓负荷评分(2.41±0.68)分高于对照组(1.85±0.72)分(t＝3.66，P<0.001)。经救治观察组有效18例(85.71%)高于对照组11例(52.38%)(P＝0.048)。截至随访结束，生存者37例(88.09%)，死亡者5例(11.90%)，轻度出血8例(19.05%)，中度出血1例(2.39%)。

结论

UACDT治疗中高危PE患者，以低剂量率rt-PA延长溶栓时间，有助于改善肺循环动力学参数，不增加出血风险，耐受性良好。

关键词: 急性肺栓塞, 重组组织型纤溶酶原激活剂, 超声辅助导管定向溶栓, 血流动力学参数
Objective

To analyze the effects of recombinant tissue plasminogen activator (rt-PA) dosage on pulmonary artery pressure and bleeding risk during ultrasound-assisted catheter-directed thrombolysis (UACDT) in patients with intermediate- to high-risk acute pulmonary embolism (PE).

Methods

This retrospective study included 42 patients with intermediate-to-high-risk acute pulmonary embolism (PE) treated with UACDT at our hospital from February 2020 to December 2024. Patients were divided into two groups based on their cumulative rt-PA dose: 21 patients with rt-PA ≤ 24 mg were in the control group, and 21 patients with rt-PA > 24 mg were in the observation group. The cumulative rt-PA dose, changes in systolic pulmonary artery pressure (sPAP), and postoperative complications were recorded during treatment. Right ventricular pressure load and hemodynamic parameters, including sPAP, mean pulmonary artery pressure (mPAP), and diastolic pulmonary artery pressure (dPAP), were compared between the two groups. The relationship between cumulative rt-PA dose and postoperative bleeding risk was analyzed.

Results

The mean treatment time for UACDT was (61.89±28.76) h, and the cumulative rt-PA was (43.28±30.03) mg. sPAP showed a decreasing trend with increasing cumulative rt-PA (F=12.451, P<0.001). In the control group, after treatment, 10 cases (47.62%) had normal right ventricular load, 9 cases (42.86%) had mild right ventricular load, 1 case (4.76%) had moderate right ventricular load, and 1 case (4.76%) had severe right ventricular load (P<0.001). In the observation group, after treatment, 14 cases (66.67%) had normal right ventricular load, 7 cases (33.33%) had mild right ventricular load, and there were no moderate or severe cases (P<0.001). After treatment, sPAP, mPAP, and dPAP in both groups decreased compared to before treatment (P<0.05). After treatment, the sPAP (43.10±4.90)mmHg, mPAP (23.10±3.20)mmHg, and dPAP (17.60±2.70)mmHg in the observation group were lower than those in the control group (sPAP (49.80±5.40)mmHg, mPAP (26.70±3.80)mmHg, and dPAP (20.70±3.10)mmHg (P<0.05). After treatment, the pulmonary vascular resistance (201.20±28.80)dyn·s·cm-5 in the observation group was lower than that in the control group PVR (265.40±35.10)dyn·s·cm-5 (P<0.001). The average postoperative intensive care unit (ICU) stay was (4.89±3.14) days, and the total hospital stay was (8.01±5.38) days. Complete thrombolysis was achieved in 18 cases (85.71%) in the observation group, higher than in 10 cases (48.00%) in the control group (χ2=6.886, P=0.032); the average thrombus burden score was (2.41±0.68) points, higher than in the control group (1.85±0.72) points (t=3.66, P<0.001). Complete effectiveness was achieved in 18 cases (85.71%) in the observation group, higher than in 11 cases (52.38%) in the control group (P=0.048). At the end of follow-up, 37 patients (88.09%) survived, 5 patients (11.90) died, 8 patients (19.05%) experienced mild bleeding, and 1 patient (2.39%) experienced moderate bleeding.

Conclusion

UACDT treatment of intermediate-to high-risk PE patients with low-dose-rate rt-PA to prolong thrombolysis time helps improve pulmonary circulatory dynamic parameters, does not increase bleeding risk, and is well tolerated.

Key words: Acute pulmonary embolism, Recombinant tissue plasminogen activator, Ultrasound-assisted catheter-directed thrombolysis, Hemodynamic parameters
图1 典型病例的CTPA图像。图A、B为双侧肺动脉出现肺栓塞；图C、D为右心室和左心室测量显示右心室/左心室直径比为1.9，间隔向左弯曲进一步支持右室心肌应变
表1 UACDT治疗PE患者rt-PA及sPAP变化(±s)
例数 治疗时间(h) 累计rt-PA(mg) sPAP (mmHg)
42 19.45±4.52 11.78±4.67 43.01±12.32
38 43.01±4.76 27.16±10.44 41.56±13.36
26 63.86±5.68 42.34±14.41 37.56±14.45
13 89.17±3.64 63.98±23.76 34.35±14.31
4 113.35±2.14 98.89±31.13 47.93±16.32
1 137.89 158.26 38.32
表2 两组PE患者血流动力学参数变化(±s)
血流动力学参数 观察组 对照组
治疗前 治疗后 治疗前 治疗后
sPAP(mmHg) 73.50±5.80 43.10±4.90 65.20±6.30 49.80±5.40
mPAP(mmHg) 35.60±3.90 23.10±3.20 33.00±4.2 26.70±3.80
dPAP(mmHg) 31.90±4.10 17.60±2.70 28.50±3.90 20.70±3.10
PVR(dyn·s·cm) 525.70±47.30 201.20±28.80 470.30±50.60 265.40±35.10
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你好！我是《中华医学电子期刊资源库》AI小编，有什么可以帮您的吗？