急性大面积肺血栓栓塞症的介入治疗  

Interventional treatment of acute massive pulmonary embolism

作　　者：马海英[1] 王承敏[1] 

机构地区：[1]大连市中心医院呼吸科,116033

出　　处：《临床肺科杂志》2006年第4期433-434,共2页Journal of Clinical Pulmonary Medicine

摘　　要：目的评估介入治疗急性大面积肺血栓栓塞症(PTE)的临床疗效。方法对15例急性大面积PTE病人进行猪尾导管碎栓抽吸血栓联合局部溶栓治疗,根据血管再通情况酌情全身溶栓,然后抗凝治疗,观察休克指数、体循环平均压、肺动脉平均压的变化。结果休克指数与体循环平均压介入后即刻与介入前相比下降显著,介入后48h继续下降,P值<0.05,均有显著性差异。肺动脉平均压介入前与介入后即刻相比改善无显著性,介入后48h改善,P值<0.05,有显著性差异。手术前后血管再通率为32.4±15.6%,无导管相关并发症,死亡率20%。结论肺血栓栓塞症的介入治疗是一种安全、有效的方法,改善近期预后,适用于急性或亚急性PTE患者,尤其适用于有溶栓禁忌症的患者。Objective To evaluate the effectiveness of pulmonary embolectomy by catheter in the treatment of acute massive pulmonary embolism. Methods Fifteen patients with severe hemodynamic impairment and massive pulmonary emboli were fragmented by mechanical action of rotating pigtail and local thrombolysis, followed by anticoagulation therapy. The measures of changes of shock index, mean systemic pressure and mean arterial pulmonary pressure was observed after the procedure. Results Average shock index decreased significantly from pre- to post-fragmentation （ P 〈 0. 05 ）, and the decrease was more pronounced in the 48 h follow-up （ P 〈 0. 05 ）. Mean systemic pressure increased significantly from pre-to post-fragmentation （ P 〈0. 05 ） , and the increase continued in the 48 h follow-up （ P 〈 0. 05 ）. The mean arterial pulmonary pressure decreased from pre- to post-fragmentation （ P 〈 0. 05 ） and the decrease was more pronounced in the 48 h follow-up （ P 〈0. 05 ）. Average percentage of recanalization by fragmentation was 32. 4% ± ＋ 15. 6%. There was no procedure - related complication. The overall mortality rate was 7 %. Conclusion Pulmonary embolectomy by catheter is a safe and effective procedure in treating acute and sub-acute massive pulmonary embolism and in improving the prognosis.

关 键 词：肺血栓栓塞症 介入治疗 栓子祛除术 

分 类 号：R563.5[医药卫生—呼吸系统] R735.7[医药卫生—内科学]