用肺动脉CTA探讨置管溶栓和静脉溶栓治疗APTE的短期疗效差异

The short-term effect difference of thrombolysis with catheter and intravenous thrombolysis for APTE by pulmonaty artery CTA

目的利用肺动脉CT血管造影(CTA)探讨置管溶栓和静脉溶栓治疗急性肺血栓栓塞(APTE)的短期疗效差异.方法前瞻性选取本院收治的APTE患者80例,根据患者意愿分为置管溶栓组(n=40)和静脉溶栓组(n=40).置管溶栓组将猪尾巴导管置于肺动脉血栓近端,经导管以50万U/d剂量泵入尿激酶,静脉溶栓组经外周静脉以同等剂量泵入尿激酶,每次泵入时间均维持2h.溶栓期间均以5000IU/12h皮下注射低分子肝素钠行抗凝治疗.所有患者治疗前1d和治疗后3d行肺动脉CTA检查,测量肺动脉阻塞指数(PAOI)、主肺动脉直径(MPAD)、主肺动脉/升主动脉直径比(rPA)和主肺动脉/降主动脉直径比(rPD).置管溶栓组治疗前1d和治疗后3d测量肺动脉压力(PAP).结果溶栓期间,两组患者均未出现脑出血、肝素诱导血小板减少症等相关严重并发症.两组患者治疗后PAOI均较治疗前显著降低,差异有统计学意义(P<0.05).治疗前两组患者PAOI差异无统计学意义(P>0.05),治疗后置管溶栓组PAOI低于静脉溶栓组,差异有统计学意义(P<0.05).两组患者治疗后MPAD、rPA和rPD均较治疗前显著降低,差异有统计学意义(P<0.05).治疗前两组患者MPAD、rPA和rPD差异无统计学意义(P>0.05),治疗后置管溶栓组MPAD、rPA和rPD低于静脉溶栓组,差异有统计学意义(P<0.05).在置管溶栓组患者中,治疗后PAP较治疗前显著降低,差异有统计学意义(t=18.115,P=0.000).治疗前PAP与MPAD、rPA、rPD存在正相关关系;治疗后PAP与MPAD、rPA、rPD也存在正相关关系.结论利用肺动脉CTA技术,能够有效判断置管溶栓治疗APTE在短期消除血栓和降低PAP方面均优于静脉溶栓.

Objective To investigate the short-term efficacy of catheter thrombolysis and intravenous thrombolysis in the treatment of acute pulmonary thromboembolism(APTE)with pulmonary artery CTA.Methods Eighty patients with APTE admitted to our hospital were prospectively selected and divided into catheter thrombolysis group(n=40)and intravenous thrombolysis group(n=40)according to the patients wishes.In the catheter thrombolysis group,the pig tail catheter was placed at the proximal end of the pulmonary artery thrombus,and the urokinase was pumped through the catheter at a dose of 500000UI/d.The intravenous thrombolytic group was pumped into the urokinase at the same dose through the peripheral vein.Each pumping time was maintained for 2h.Anticoagulant therapy was perfonned by subcutaneous injection of low molecular weight heparin sodium at 5000IU/12h during thrombolysis.All patients underwent pulmonary CTA examination 1 day before treatment and 3 days after treatment,and pulmonary artery occlusion index(PAOI)f main pulmonary artery diameter(MPAD),ratio of main pulmonary artery diameter to ascending aorta diameter(rPA)and ratio of main pulmonary artery diameter to descending aorta diameter(rPD)were measured.The pulmonary artery pressure(PAP)was measured 1 day before treatment and 3 days after treatment in the catheter thrombolytic group.Results During the thrombolysis,there were no serious complications such as cerebral hemorrhage and heparin—induced thrombocytopenia.The PAOI of the two groups was significantly lower than that before treatment,and the difference was statistically significant(P<0.05).There was no significant difference in PAOI between the two groups before treatment(P>0.05).The PAOI of the catheter thrombolysis group was lower than that of the intravenous thrombolysis group(P<0.05).The MPAD,rPA and rPD of the two groups weresignificantlyy lower than those before treatment,and the difference was statistically significant(P<0.05).There was no significant difference in MPAD,rPA and rPD between the two groups before treatment(P>0.05).The postoperative MAPD,rPA and rPD in the thrombolysis group were lower than those in the intravenous thrombolysis group(P<0.05).In the jpatients in the catheter thrombolysis group,PAP wassignificantlyy lower than that before treatment,the difference was statistically significant(t=18.115,P=0.000).There was a positive correlation between PAP and MPAD,rPA and rPD before treatment.There was also a positive correlation between PAP and MPAD,rPA and rPD after treatment.Conclusion Using the technique of pulmonary artery CTA,it is effective to determine that the thrombolytic therapy of APTE is superior to the intravenous thrombolysis in the short-term elimination of the thrombus and the reduction of PAP.