介入治疗急性肺动脉栓塞疗效

Efficacy of interventional therapy on acute pulmonary embolism

目的评价经皮血管内介入方法配合导管内溶栓治疗肺动脉栓塞的疗效和安全性。方法螺旋CT肺动脉造影(CTPA)确诊急性肺栓塞患者96例,均无溶栓、抗凝治疗禁忌证,根据患者手术意愿与否,分为观察组和对照组。观察组47例,经股静脉或肘正中静脉穿刺插管至肺动脉,采用经皮导管碎栓、吸栓、球囊扩张术和溶栓设法恢复栓塞段肺动脉前向血供,术后予以充分抗凝治疗。对照组49例采用2小时尿激酶持续溶栓,溶栓后给予抗凝治疗。观察临床症状、体征改善情况、并发症及动脉血氧分压的变化,以及肺动脉开通情况。结果观察组47例肺动脉主干血管均即刻开通前向供血,24小时后46例血氧饱和度达到100%,1例血氧饱和度达93%以上,胸闷、气短均有明显缓解。而对照组24小时溶栓结束后26例血氧饱和度达到100%,19例血氧饱和度达90%以上,4例仍位于90%以下,40例胸闷、气短有明显缓解。抗凝治疗1周后两组均复查肺动脉CTPA,提示介入治疗组42例肺动脉血栓基本消退,6例明显消退,而对照组24例肺动脉血栓基本消退,14例明显消退,8例部分消退。观察组无1例死亡,而对照组1例死于呼吸衰竭。结论对于大面积或次大面积急性肺栓塞患者,介入治疗肺动脉栓塞能及时开通肺动脉,恢复肺动脉血流动力学改变,纠正低氧血症,明显改善症状及预后,是治疗肺动脉栓塞一种有效的方法。

Objective To evaluate the efficacy and safety of intravascular interventional treatment accompanied by catheter directed percutaneous thrombosis therapy on pulmonary embolism.Methods Ninety-six patients diagnosed with acute pulmonary embolism confirmed by pulmonary artery CTPA angiography were divided into study group（n=47）and control group（n=49）based on the willingness of patients.There were no contraindications of thrombolysis and anticoagulation treatments for all patients.The patients in study group were applied with percutaneous catheter thrombolysis,balloon dilation and aspiration of thrombus to gain forward blood recanalization of segmental pulmonary artery embolized,followed by treatment of sufficient anticoagulation after operation.The patients in control group were treated for thrombolysis by urokinase application for two hours with anticoagulant therapy after thrombolysis.The changes of clinical symptoms,signs,complications and arterial partial pressure of oxygen as well as pulmonary arterial recanalization in two groups were observed.Results The trunk pulmonary arteries of the patients in study group were opened up instantly after operation and the blood oxygen saturation reached 100%for 46 patients and 93%for 1patient separately at 24 hours after operation,symptoms such as chest tightness and shortness of breath in study group were also significantly relieved.While for 49 patients in control group,the blood oxygen saturation reached 100% for 26 patients,higher than 90%for 19 patients,and less than 90%for 4patients individually at 24 hours after treatment,symptoms such as chest tightness and shortness of breath in 40 patients of control group were significantly relieved.After one week of anticoagulant therapy,the pulmonary artery thrombus in study group generally disappeared in 42 cases and apparently disappeared 6cases.The disappearance of pulmonary artery thrombus was basically for 24 cases and apparently for 6cases in control group.No death case was observed in study group but 1patient in control group died of respiratory failure.Conclusion Interventional treatment for pulmonary embolism of large area was effective due to its usefulness in timely opening up the embolized pulmonary artery,recovery of blood dynamics,improvement of hypoxemia and alleviation of clinical uncomfortableness as well as better prognosis.