目的 探讨微创介入介导联合重组组织纤溶酶原激活剂（rt-PA）对大面积肺栓塞（MPE）相关患者生存率的影响。 方法 回顾性地将2021年10月至2024年10月在黔东南苗族侗族自治州人民医院就诊接受微创介入介导联合rt-PA治疗的患者纳入研究组（103例），采用倾向评分匹配（PSM）评分法匹配同期医院接受那屈肝素钙及rt-PA治疗的患者纳入对照组（97例）。比较两组的临床总有效率、治疗30 d及90 d后生存率、生命体征指标［心率（HR）、呼吸频率］、血气指标［动脉血氧分压（PaO₂）、二氧化碳分压（PaCO₂）、肺动脉压（PAP）及外周血氧饱和度（SpO₂）］、凝血与纤溶系统关键参数［D-二聚体（D-D）、纤溶酶原激活物抑制剂-1（PAI-1）、组织型纤溶酶原激活物（t-PA）、血栓调节蛋白（TM）及抗凝血酶Ⅲ（AT-Ⅲ）］、血流动力学指标及总不良反应率。 结果 治疗后，研究组的总体治疗有效率为95.15%，显著高于对照组的81.44%（P < 0.05）。治疗30 d后，两组的生存率差异无统计学意义（P > 0.05）；治疗90 d后，研究组的生存率为94.13%，显著高于对照组的85.57%（P < 0.05）。治疗前，两组的HR及呼吸频率均差异无统计学意义（P > 0.05）；治疗后，两组的HR及呼吸频率均呈显著性降低趋势，且研究组显著低于对照组（P < 0.05）。治疗前，两组的PaO₂、PaCO₂、PAP及SpO₂均差异无统计学意义（P > 0.05）；治疗后，两组的PaO₂、PaCO₂及SpO₂均呈现显著上升趋势，且研究组显著高于对照组（P < 0.05）；治疗后，两组的PAP均呈现显著下降趋势，且研究组显著低于对照组（P < 0.05）。治疗前，两组的D-D、PAI-1、t-PA、TM及AT-Ⅲ均差异无统计学意义（P > 0.05）；治疗后，两组的D-D、PAI-1、t-PA、TM均呈现显著下降趋势，且研究组显著低于对照组；AT-Ⅲ呈上升趋势，且研究组高于对照组（P < 0.05）。治疗前，两组的RV/LV比值、sPAP、TAPSE均差异无统计学意义（P > 0.05）；治疗后，两组RV/LV比值、sPAP均显著下降，TAPSE显著升高（P < 0.001），且研究组RV/LV比值、sPAP的下降幅度和TAPSE的升高幅度均优于对照组（P < 0.05）。两组总体出血事件发生率差异无统计学意义（25.77% vs. 16.67%，P > 0.05），但根据BARC分级标准，对照组BACR 3型及以上出血事件发生率高于研究组。 结论 微创介入介导联合rt-PA对大面积肺栓塞，可以有效改善氧合功能，调节凝血纤溶平衡，提高临床有效率。

Objective To investigate the impact of minimally invasive intervention combined with rt-PA on survival rates in patients with massive pulmonary embolism （MPE）. Methods Retrospectively， patients who received minimally invasive interventional combined rt-PA treatment in our hospital from October 2021 to October 2024 were included in the study group （103 cases）， and propensity score matching （PSM） scoring method was used to match patients who received Nadroparin calcium and rt-PA treatment in our hospital during the same period into the control group （97 cases）. Comparisons were made between the two groups regarding overall clinical efficacy， 30-day and 90-day post-treatment survival rates， vital signs ［heart rate （HR）， respiratory rate］， blood gas parameters ［arterial oxygen partial pressure （PaO₂）， carbon dioxide partial pressure （PaCO?）， pulmonary artery pressure （PAP）， and peripheral oxygen saturation （SpO?）］， coagulation and fibrinolysis system markers ［D-dimer （D-D）， plasminogen activator inhibitor-1 （PAI-1）， tissue plasminogen activator （t - PA）， thrombomodulin （TM）， and antithrombin Ⅲ （AT-Ⅲ）］， Blood flow dynamics index and total adverse reaction rates. Results After treatment， the overall efficacy rate in the study group was 95.15%， significantly higher than the control group′s 81.44% （P < 0.05）. At 30 days post-treatment， there was no significant difference in survival rates between the two groups （P > 0.05）. At 90 days post-treatment， the survival rate in the study group was 94.13%， significantly higher than that in the control group （85.57%， P < 0.05）. Pretreatment HR and respiratory rate showed no significant differences between the two groups （P > 0.05）； post - treatment， both groups exhibited significant reductions in these parameters， with the study group demonstrating lower values than the control group （P < 0.05）. Pretreatment PaO?， PaCO?， PAP， and SpO? showed no significant differences （P > 0.05）； post-treatment， PaO?， PaCO?， and SpO? significantly increased in both groups， with the study group outperforming the control group （P < 0.05）， while PAP significantly decreased， with the study group showing lower values than the control group （P < 0.05）. Before treatment， there was no significant difference between the two groups in D - D， PAI-1， t-PA， TM and AT-Ⅲ （P > 0.05）. After treatment， D-D， PAI-1， t-PA and TM showed a significant downward trend in both groups， and the study group was significantly lower than the control group； AT-Ⅲ showed an upward trend， and the study group was higher than the control group （P < 0.05）. Before treatment， there was no significant difference in RV/LV ratio， sPAP and TAPSE between the two groups （P > 0.05）； after treatment， RV/LV ratio and sPAP decreased significantly， while TAPSE increased significantly （P < 0.001）， and the decrease of RV/LV ratio and sPAP and increase of TAPSE in the study group were better than those in the control group （P < 0.05）. There was no statistical difference in the incidence of overall bleeding events between the two groups （25.77% vs. 16.67%， P > 0.05）， However， according to the BARC classification criteria， the incidence of hemorrhagic events of type 3 or higher was higher in the control group than in the study group. Conclusion Minimally invasive intervention combined with rt-PA effectively improves oxygenation， regulates coagulation-fibrinolysis balance， and enhances clinical efficacy in patients with massive pulmonary embolism.