急性肺动脉栓塞的肺动脉留置导管溶栓治疗56例经验

Indwelling transpulmonary artery thrombolytic therapy for acute pulmonary embolism

目的 总结肺动脉留置导管溶栓治疗急性肺动脉栓塞的疗效,以减轻肺栓塞症状、降低死亡率及慢性阻塞性肺病的发生.方法 回顾性分析201 1年6月至2013年6月内蒙古赤峰市立医院经CT确诊的56例急性肺动脉栓塞患者的临床资料,平均年龄（56±11）岁,行下腔静脉滤器植入与肺动脉造影,导管碎栓、溶栓治疗,术后联合应用低分子肝素和华法林,调整凝血酶原国际标准化率在2～3.结果 56例患者中,随访45例,随访率80.4％.随访时间3～24个月,平均随访时间（15±4）个月,平均肺动脉压（mPAP）从（43±7）mmHg降到（22 ±6） mmHg（P ＜0.05）,动脉血氧分压（PO2）从（49±8）mmHg升到（83±9）mmHg （P＜0.05）,即刻临床症状明显改善,显效51例,显效率91％ （51/56）有效率100％,56例患者45例获得随访,平均（15 ±4）个月,1例复发,无滤器移位、腔静脉血栓形成、慢性阻塞性肺病等并发症的发生.结论 肺动脉留置导管溶栓治疗急性肺动脉血栓栓塞症是安全有效的.

Objective To evaluate indwelling intrapulmonary artery catheter thromolysis for acute pulmonary embolism.Methods From June 2011 to June 2013 56 cases of acute pulmonary embolism were diagnosed by multi-row spiral CT and admitted at the Department of Vascular Surgery.The average age was （56 ± 11） years.Inferior vena cava filter was implanted and pulmonary angiography,catheter thrombectomy,indwelling pulmonary intraarterial thrombolytic therapy was performed.Postoperatively low molecular weight heparin and warfarin was given,dosage adjusted by prothrombin international normalized ratio at 2-3.Results Mean pulmonary arterial pressure （mPAP） decreased from （43 ± 7） mmHg to （22 ± 6） mmHg （P ＜ 0.05）,arterial partial pressure of oxygen （PO2） rose from （49 ± 8） mmHg to （83 ± 9） mmHg （P ＜ 0.05）.Clinical symptoms significantly relieved in 51 out of the 56 cases （91％）.45 patients were followed up for an average of （15 ± 4） months,with one recurrence.There was no filter migration,vena cava thrombosis,chronic obstructive pulmonary disease and other complications.Conclusions Emergency pulmonary artery indwelling catheter thrombolysis is safe and effective therapy for acute pulmonary thromboembolism.