AngioJet流变抽栓系统联合导管接触性溶栓治疗急性高危肺动脉栓塞的疗效

Efficacy of AngioJet rheological thrombectomy system combined with catheter contact thrombolysis in the treatment of acute high-risk pulmonary embolism

目的探讨AngioJet流变抽栓系统(ART)联合导管接触性溶栓(CDT)治疗高危急性肺动脉栓塞(APE)的有效性和临床安全性。方法收集2019年9月至2020年10月佳木斯大学附属第一医院收治的经外周系统尿激酶溶栓效果不佳的20例APE患者的临床资料,包括大面积肺栓塞(MPE)患者12例和次大面积肺栓塞(SMPE)患者8例,均急诊行ART联合CDT治疗。观察技术成功率和手术成功率;比较手术前后的临床指标变化情况,指标包括休克指数(SI)、Miller指数(MI)、平均肺动脉压(MPAP)及动脉氧分压(PaO_(2));观察患者的手术及并发症发生情况;评估ART联合CDT治疗对肺动脉内血栓的清除效果。结果ART联合CDT治疗APE患者的技术成功率为100%(20/20),术中所有患者均出现一过性心动过缓和不同程度的心律失常,2例患者出现严重的心律失常,3例患者出现心脏骤停,手术成功率为75%(15/20)。MPE和SMPE患者的术后临床症状明显改善,术后SI、MI、MPAP均较术前降低,PaO_(2)较术前升高,差异均有统计学意义(P<0.05)。20例APE患者顺利出院。随访期间,1例MPE患者因意外死亡而随访终止,其余患者无明显的肺栓塞症状,肺动脉血栓明显减少或消失。结论ART联合CDT治疗APE的疗效确切,安全可靠,值得临床推广应用。

Objective To investigate the clinical safety and effectiveness of AngioJet rheological thrombosis system(ART)combined with catheter directed thrombolysis(CDT)in the treatment of acute high-risk pulmonary embolism(APE).Method The clinical data of 20 patients with APE who were admitted to the First Affiliated Hospital of Jiamusi University from September 2019 to October 2020 were selected.They had poor efficacy in thrombolysis by peripheral urokinase,including massive pulmonary embolism(MPE)12 cases and 8 cases of sub-major pulmonary embolism(SMPE)were treated with ART combined with CDT in emergency.The technical success rate and surgical success rate were observed.The shock index(SI),Miller index(MI),mean pulmonary artery pressure(MPAP)and arterial partial pressure of oxygen(PaO2)were compared before and after surgery to evaluate the efficacy of ART combined with CDT in removing thrombosis in the pulmonary artery.Result The technical success rate of ART combined with CDT in the treatment of APE was 100%(20/20).During the surgery,all patients had transient bradycardia and various degrees of arrhythmia,2 had severe arrhythmia,and 3 patients had cardiac arrest.The surgery success rate was 75%(15/20).The clinical symptoms of all MPE and SMPE patients were significantly improved after surgery.SI,MI,MPAP after surgery were lower than before surgery,and PaO2 was higher than before,the difference was statistically significant(P<0.05).Twenty patients with APE were discharged from the hospital.During the follow-up period,one MPE patient died due to accidental follow-up.The remaining patients had no obvious symptoms of pulmonary embolism,and pulmonary artery thrombosis was significantly reduced or disappeared.Conclusion ART combined with CDT has good safety and effectiveness in the treatment of APE,providing a new treatment strategy for APE patients.