经导管局部注射瑞替普酶溶栓治疗急性大面积肺动脉血栓栓塞26例临床分析

Clinical efficiency and safety of transcatheter contact thrombolysis with reteplase in the treatment of acute massive pulmonary thromboembolism： a report of 26 cases

目的 探讨经导管注射瑞替普酶溶栓治疗急性大面积肺动脉血栓栓塞的疗效及安全性.方法 26例急性大面积肺动脉血栓栓塞患者,经急诊肺动脉内导管碎栓和局部灌注瑞替普酶溶栓治疗,观察处理前后肺循环改善情况,分析心肺血流动力学的改变.结果 26例急性大面积肺栓塞患者术前平均肺动脉压、动脉血氧分压和收缩压分别为（63.78±6.89） mmHg、（73.23±11.51）mmHg和（103.35±10.92）mmHg,术后分别为（26.23±10.27） mmHg、（93.48 ±9.17）mmHg和（127.14±13.15） mmHg,治疗前后比较差异均有统计学意义（P＜0.01）.随访6～36个月,24例（92％）疗效持续,未见复发.结论 急诊肺动脉内碎栓联合经导管注射瑞替普酶溶栓治疗能迅速改善急性大面积肺栓塞患者肺循环梗阻状况和临床症状,未见明显并发症,对维持血流动力学稳定有重要作用.

Objective To evaluate the effect, techniques and Safety of intrapulmonary interven- tional therapy for patients with acute massive pulmonary thromboembolism（PTE）. Methods 26 patients （17males,9 females） diagnosed acute massive pulmonary embolism admitted from June 2010 to June 2013 were underwent intrapulmonary fragmentation using catheters and contact thrombolysis with rPA（ re- teplase, rPA）. The pulmonary angiography and changes of pulmonary circulation as well as clinical mani- festations before and after procedure were compared. Results The mPAP decreased from （63.78 ± 6.89） mmHg to （26.23 ＋ 10.27 ）mmHg, PO2 elevated from （73.23 ± 11.51 ） mmHg to （93.48 ± 9.17 ） mmHg, and SBP elevated from（ 103.35 ± 10.92）mmHg to （127.14 ± 13.15 ）mmHg,showing a significant differ- ence （P 〈 0. 01 ） before and after the therapy. The immediate clinical symptoms exhibited a significant im- provement. During 6 to 36 months＇ follow up, the therapeutic effects of 24 patients （92%）were persisted and no recurrence. Conclusion The emergent trascatheter contact thrombolysis therapy with reteplase may be effective, safe, and economic for treatment of acute massive pulmonary thromboembolism, and can improve pulmonary obstruction and decrease clinical symptoms without significant complications.