紧急肺动脉内介入治疗急性中/大块肺栓塞初步经验

Initial experience of emergent intrapulmonary interventional therapy for acute sub-massive/massive pulmonary embolism

目的 了解紧急肺动脉介入治疗对中 /大块急性肺栓塞患者的疗效及安全性。方法经紧急肺动脉造影确诊后、即刻行肺动脉内导管机械性碎栓、吸栓及接触性尿激酶溶栓治疗 ,观察处理前后的肺循环梗阻及症状改善情况。结果 8例经紧急肺动脉造影确诊伴肺动脉高压患者 (男 6例 ,女 2例 ,平均年龄 6 3 3± 15 0岁 )。处理前后Miller指数从 0 5 1± 0 17减小至 0 2 9± 0 15 (P <0 0 0 1) ,肺动脉收缩压从 (5 9 75± 2 2 6 5 )mmHg降至 (42 75± 16 6 4 )mmHg(P <0 0 5 )。术后 7例症状明显改善 ,死亡 1例。置入下腔静脉滤器 2例。经 2周静脉内溶栓、抗凝、抗血小板聚集等治疗 ,7例患者临床表现完全缓解。结论 用普通导管紧急肺动脉内碎栓、吸栓、接触性溶栓治疗能迅速改善重症肺栓塞肺循环梗阻状况 ,改善临床症状 ,未见明显并发症 ,安全有效 ,治疗消费较低廉。

Objective To observe the security and effects of intrapulmonary interventional therapy in patients with acute sub-massive/massive pulmonary embolism (PE). Methods Emergent pulmonary angiography was followed by intrapulmonary fragmentation and sucking of massive pulmonary emboli using different cathethers, and contact thrombolysis with urokinase .The changes of pulmonary circulation as well as clinical manifestations were compared before and after treatment in all the patients. Results Eight patients (6 male,2 female, age 63.3±15.0 years) with unstable hemodynamics were diagnosed as acute sub-massive / massive PE with hyper-pulmonary artery pressure in pulmonary angiography. The average Miller index were improved from 0.51±0.17 to 0.29±0.15( P <0.001), pulmonary pressure decreased from 59.75±22.65 mm Hg to 42.75±16.64 mm Hg( P <0.05) and clinical symptoms were taken a turn for the better. No patient had a significant complication. One patient died in three days after the procedure. Two patients accepted implantation of an inferior vena cava filter. Seven patients were recovered after following two weeks′ intravenous thrombolytic, anticoagulation and antiplatelet therapies. Conclusion The emergent intrapulmonary interventional therapy was effective, safe and better cost-effective in acute sub-massive/massive pulmonary embolism, resulting in improved pulmonary obstruction and decreased clinical symptoms, without significant complications.