单纯经皮机械祛栓治疗急性大面积肺栓塞的临床应用

Percutaneous mechanical thrombectomy for the treatment of acute massive pulmonary embolism:its preliminary clinical application

目的评价单纯介入机械祛栓在治疗急性大面积肺栓塞(PE)方面的临床疗效和安全性。方法回顾性收集2003年1月到2008年1月经皮机械碎栓(PMT)或(和)Straub Rotarex系统祛栓治疗急性大面积PE病例6例。结果6例患者的肺动脉主干血流得以再通且临床症状改善。介入术后,患者SaO2从术前79.5%±5.3%增加至92.8%±3.4%(P<0.01);PaO2从术前从(58.0±9.8)mmHg增加至(88.7±4.1)mmHg(P<0.01);术后患者的平均肺动脉压(PAP)从(40.8±7.8)mmHg降至(29.8±8.0)mmHg(P<0.01);Miller指数从术前的0.54±0.03降至术后的0.18±0.07(P<0.01)。在完成临床随访的4例患者中,1～5年内均未有PE复发。结论初步临床经验显示单纯PMT是治疗急性大面积PE的一种简单、有效、安全的方法,尤其是针对有溶栓禁忌证的患者。

Objective Acute massive pulmonary embolism（PE） is a clinical emergency requiring rapid and supportive measures.With the development of interventional technology and devices,percutaneous mechanical thrombectomy（PMT） is considered to be an alternative for the treatment of PE,though there is still relative lack of clinical experience.The purpose of this study is to evaluate the clinical efficacy and safety of PMT in the management of acute massive PE.Methods The clinical data of massive PE patients treated with interventional methods were collected and analyzed in a retrospective way.From Jan.2003 to Jan.2008,6 patients（5 males and one female,with a mean age of 62 years） with acute massive PE,which was initially diagnosed by computed tomography and finally confirmed by pulmonary angiography,were treated with percutaneous catheter fragmentation and / or Straub Rotarex thrombectomy device.Results The improvement of clinical status and restoration of blood flow in the main branches of pulmonary artery were obtained in all patients.Oxygen saturation（SaO2） increased from preoperative（79.5 ± 5.3）% to postoperative（92.8 ± 3.4）%,with P〈0.01.Partial arterial oxygen pressure（PaO2） increased from preoperative（58.0 ± 9.8） mmHg to postoperative（88.7 ± 4.1） mmHg（P〈0.01）.After PMT treatment,the mean pulmonary artery pressure（PAP） decreased from preoperative（40.8 ± 7.8） mmHg to postoperative（29.8 ± 8.0） mmHg（P〈0.01）.Miller index decreased from preoperative 0.54 ± 0.03 to postoperative 0.18 ± 0.07（P〈0.01）.During a clinical follow-up period ranged from 1 to 5 years,four patients showed no recurrence of PE,the other two patients lost touch with the authors.Conclusion The preliminary experience in our series suggests that PMT is an easy,effective and safe therapy in the clinical management of acute massive PE,especially when thrombolysis is contraindicated.