急性肺动脉栓塞的治疗策略(附48例报道)

Therapeutic Strategy of Acute Pulmonary Embolism: Analysis of 48 Cases

目的探讨急性肺动脉栓塞的治疗策略。方法回顾性分析川北医学院附属医院血管外科2009年1月至2014年5月期间收治的48例肺动脉栓塞患者的临床资料,分析其临床疗效及并发症发生情况。结果 48例患者中,14例低危患者行抗凝治疗,24例中危患者行抗凝和系统溶栓或介入治疗（导管捣碎局部溶栓或置管溶栓）,10例高危患者行抗凝治疗和介入治疗。低危组14例患者中,治愈12例（85.7%）,显效2例（14.3%）,总有效率为100%;中危组24例患者中,治愈16例（66.7%）,显效8例（33.3%）,总有效率为100%;高危组10例患者中,治愈3例,显效2例,好转4例,死亡1例,总有效比例为9/10。治疗期间所有病例均无消化道出血、脑出血等并发症发生。本组48例患者均获访,随访时间为3~12个月,中位数为8个月。随访期间患者均无呼吸困难等症状发生,无一例再发肺动脉栓塞,无滤器移位、血栓形成等并发症发生。结论对诊断明确的急性肺动脉栓塞患者首先进行危险分层,再采取相应的治疗策略,则效果较好。

Objective To investigate therapeutic strategy of acute pulmonary embolism. Methods Clinical data of 48 patients with acute pulmonary embolism who were treated in Affiliated Hospital of North Sichuan Medical College form January 2009 to May 2014 were analyzed retrospectively. Results Of the 48 cases, 14 cases of low risk（low risk group） were treated with anticoagulation, 24 cases of middle risk（middle risk group） were treated with anticoagulation and systematic thrombolysis or interventional therapy（local thrombolysis after thrombus fragmentation or thrombolytic catheter placement in pulmonary artery）, 10 cases of high risk（high risk group） were treated with anticoagulation and interventional therapy. In low risk group, 12 cases（85.7%） were cured and 2 cases（14.3%） were markedly effective, and total effective rate was 100%. In middle risk group, 16 cases（66.7%） were cured and 8 cases（33.3%） were markedly effective, and total effective rate was 100%. In high risk group, 1 case died, 3 cases were cured, 2 cases were markedly effective, and 4 cases were better, and the total effective ratio was 9/10. All cases suffered from no complication such as hemorrhage of cerebral and digestive system. Forty-eight cases were followed up for 3-12 months, with a median time of 8 months. During the follow-up period, there was no complication occurred such as dyspnea, pulmonary embolism, placement change of filter net, and thrombosis. Conclusions Corresponding therapeutic strategy would be taken according to risk stratification of the acute pulmonary embolism.