肺血栓塞栓症のウロキナーゼによる血栓溶解療法—18例の集計成績

Thrombolytic therapy of pulmonary thromboembolism result of eighteen patients

　肺血栓塞栓症pulmonary thromboembolism （以下PTE）に討しての血栓溶解（線溶）療法を含めた治療法は，欧米においてはほぼ確立されている^1〜4）。しかし，本邦では，近年症例が増加してきた^5）とはいえ，欧米に比して少ないこともあり，一定した治療法は確立されていない。治療のうち線溶療法については，症例報告が増加している^6〜9）が，ウロキナーゼ製剤（以下UK）の一定した使用法はなく，単に個人的な経験や見解に頼って投与されている現状である。今回，日本におけるPTEの血栓溶解療法の現状を把握し，今後の線溶療法の基準作成の参考にするため，著者らは，厚生省の循環器病委託研究による肺血栓塞栓性疾患の診断と治療に関する研究班（班長：吉良枝郎教授：順天堂大学）治療分科会班員の経験症例を中心にアンケート調査を行った。そこでUKによる線溶療法の18例の成績をまとめ，症例の重症度，UKの投与量，効果などについて若干の考察を加えて報告する。

In Japan, pulmonary thromboembolism (PTE) is rare and the therapy of this disease, especially the thrombolytic therapy, has not been established yet. We studied the effect of thrombolytic therapy by urokinase (UK) in eighteen patients with PTE. We also compared the results with those in Europe and the United States.

Eighteen patients (male 7, female 11) were 27 yo to 77 yo (mean 55 yo). Seven cases were mild and 11 cases were moderate to severe. The initial dosage of UK administration was 2. 4×10⁵ to 7.2×10⁵ IU with the mean of 4.1×10⁵ IU, which was approxi-mately the double of those in Europe and the US.

The duration of UK therapy was 1 to 9 days with the mean of 4. 8 days. It was longer than in Europe and the US (12-24 hours). Total amoumt of UK in each case ranged 4. 8×10⁵ to 42×10⁵IU (mean 19.3 x 10⁵ IU) with the daily dosage of 4.0×10⁵IU in average. They were almost half of those in Europe and the US. Clinical signs and laboratory findings subsided in 1-7 day by UK administration in 14 cases (87%) with the reduction of defects on perfusion lung scans and all of these cases survived. No severe complications were found in any cases.

We conclude that the thrombolytic therapy with UK in Japan might be acceptable from the results of this present study.

However, the prospective study of thrombolytic therapy on a larger scale remains to be done in the future.