静脉溶栓联合导管碎栓和切栓治疗急性大面积肺栓塞

System thrombolysis combined with percutaneous catheter fragmentation and thrombectomy in acute massive pulmonary embolism

目的评价静脉溶栓联合导管碎栓和切栓治疗急性大面积肺栓塞的临床疗效和安全性。方法对19例急性大面积肺栓塞患者,采用下腔静脉滤器置入、肺动脉导管碎栓和静脉溶栓加低分子肝素抗凝治疗,19例中4例加用了 Straub Rotarex 导管血栓旋切术。结果 19例共行21次治疗。18例经介入治疗后胸闷、紫绀症状均明显改善,肺动脉中央分支血流恢复通畅,血氧饱和度由术前平均86%(74%～96%)上升到治疗后的平均97%(94%～100%)。肺动脉压力从术前的(33±5)mm Hg(1 mm Hg=0.133 kPa)下降到术后的(25±5)mm Hg(t=13.2,P<0.01)。1例双侧肺动脉主干大块血栓栓塞的患者,介入治疗无效,后经胸外科手术取栓未能成功,患者死亡。4例成功地采用了 Straub Rotarex 旋切治疗肺动脉血栓,未出现并发症。结论采用导管碎栓和血栓旋切等介入技术联合静脉溶栓抗凝治疗,是治疗急性大面积肺动脉栓塞的有效而且安全的方法。

Objective To evaluate the safety and clinical efficacy of system thrombolysis combined with percutaneous catheter thrombus fragmentation and thrombectomy for acute massive pulmonary embolism. Methods Ninteen patients with acute massive pulmonary embolism were treated with IVC filter placement, percutaneous catheter thrombus fragmentation and system thrombolysis combined with anticoangulation using low-molecular-weight heparin. Four of 19 patients underwent adjuvant Straub Rotarex catheter thrombectomy. Results Twenty-one procedures were performed in 19 patients. Improvement of pulmonary artery patency and initial relief of symptoms immediately occurred in 18 of 19 patients after interventional therapy. The oxygen saturation increased from 86% to 97%. Pulmonary artery pressure decreased from 33 ± 5 mm Hg（ 1 mm Hg -- 0. 133 kPa） to 25 ± 5 mmHg after interventional therapy （ t = 13.2, P 〈 0.01 ）. One patient with bilateral pulmonary artery trunk massive thrombus failed to be treated with interventional therapy and system thrombolysis, and died during the procedure of surgical thromboectomy. Technical success was achieved in 4 patients with Straub Rotarex thromboectomy and no complication occurred. Condusion System thrombolysis combined with percutaneous catheter fragmentation and thrombectomy was effective and safe in patients with acute massive pulmonary embolism.