经皮导管介入术治疗急性肺栓塞的初步探讨

Efficacy and safety of catheter-directed interventional therapy in patients with acute pulmonary embolism

目的探讨经皮导管介入术治疗急性肺栓塞患者的疗效及安全性。方法本研究为回顾性分析。入选2016年5月至2017年12月在陆军军医大学第二附属医院心内科就诊的79例急性肺栓塞患者作为研究对象,其中男性49例,年龄(58.9±14.9)岁,经CT肺动脉造影证实后进行危险分层,并进一步分为2个亚组,即高危组28例、中危组51例。对入选者行经皮导管介入术(包括血栓抽吸、球囊碎栓及经导管溶栓等)进行治疗,观察手术前、后患者肺动脉平均压、右心室舒张末期内径/左心室舒张末期内径比值、血氧分压和氧饱和度等肺血流动力学指标的变化,并观察患者咯血、出血、心包填塞、呼吸困难加重、死亡、再次栓塞等安全性指标。结果经皮导管介入术前、后患者肺动脉平均压由(35.3±11.2)mmHg(1mmHg=0.133kPa)降至(30.0±10.6)mmHg(t=8.803,P<0.05)、右心室舒张末期内径/左心室舒张末期内径比值由0.93±0.16降至0.83±0.15(t=6.868,P<0.05),血氧分压由(69.0±8.6)mmHg升至(75.1±9.9)mmHg(t=8.561,P<0.05),术后24h血氧饱和度由(93.9±2.9)%升至(95.1±1.9)%(t=2.621,P<0.05)。亚组分析发现经皮导管介入术治疗后高危组和中危组患者肺动脉平均压、右心室舒张末期内径/左心室舒张末期内径比值均明显下降(t值分别为2.640和2.651,P均<0.05),其中高危组二者变化值均大于中危组(U值分别为424.5和502.5,P均<0.05)。所有患者均未发生咯血、心包填塞和大出血,5例患者发生小出血,3例患者术后呼吸困难加重需要呼吸机辅助治疗,1例患者死亡,1例患者再次肺梗塞。结论经皮导管介入术治疗急性肺栓塞中高危患者有效且安全。

ObjectiveTo evaluate the efficacy and safety of catheter-directed interventional therapy in patients with acute pulmonary embolism(PE).MethodsPE was diagnosed by CT pulmonary angiography(CTPA). After risk stratification, a total of 79 PE patients (age (58.9±14.9) years old)were treated with catheter-directed interventional therapy via pulmonary vessels. The changes of pulmonary hemodynamics were compared before and after treatment. The risk of complications and side effects were observed.ResultsThe pulmonary artery pressure was changed followed by interventional therapy. The interventional therapy significantly decreased mean pulmonary arterial pressure (mPAP) from (35.3±11.2)mmHg (1 mmHg=0.133 kPa) to (30.0±10.6)mmHg (t=8.803,P<0.05) and the echocardiographic derived right ventricular dimension to left ventricular dimension (RV/LV) ratio from 0.93±0.16 to 0.83±0.15 (t=6.868,P<0.05). The arterial partial pressure of oxygen was increased from (69.0±8.6)mmHg to (75.1±9.9)mmHg (t=8.561,P<0.05) . The oxygen saturation was also increased from (93.9±2.9)% to (95.1±1.9)% at 24 h after the treatment (t=2.621,P<0.05) . Patients were further grouped as high-risk group (n=28) and intermediate risk group (n=51). mPAP and RV/LV ratio were significantly reduced in the two subgroups (all P<0.05) and the range of reduction was more significant in the high-risk group. Five patients experienced minor bleeding complication, 3 patients suffered worsened dispone post procedure and were treated with mechanical ventilation, 1 patient died, and 1 patient developed recurrent PE.ConclusionThe catheter-directed interventional therapy improves pulmonary hemodynamics and reduces load of right ventricle both in high-risk or intermediate risk PE patients, this therapy strategy is safe and effective for patients with PE.