肺动脉置管溶栓术治疗肺栓塞(附65例报告)  

Observation on the effect of transcatheter thrombolysis therapy for pulmonary thromboembolism in 65 cases

作　　者：肖亮[1] 童家杰[1] 申景[1] 徐克[1] 

机构地区：[1]中国医科大学附属第一医院,沈阳110001

出　　处：《山东医药》2011年第31期1-3,共3页Shandong Medical Journal

基　　金：国家十一五科技支撑计划项目(2007BAI05B04)

摘　　要：目的探讨肺动脉置管溶栓术治疗肺动脉血栓栓塞(肺栓塞)的临床疗效及安全性。方法对65例肺栓塞患者行肺动脉置管溶栓术;57例合并静脉血栓者经股静脉或右颈内静脉置入腔静脉滤器,溶栓治疗结束前复查肺动脉造影及下肢静脉造影。出院后长期口服华法林。术后6个月复查血管超声及肺动脉3D CT血管造影。结果置入腔静脉滤器57枚,均一次性释放成功,释放过程平均耗时2.2 m in,滤器弹跳幅度<2 mm且无倾斜。65例患者平均溶栓时间6.72 d。溶栓治疗后呼吸困难消失55例,呼吸困难减轻7例,死于呼吸、循环衰竭1例。血栓明显消融52例,部分消融11例,少量消融1例。术后合并脑出血1例。6个月后复查肺动脉及肢体静脉血栓无明显增多。结论肺动脉置管溶栓术治疗肺栓塞效果确切,可明显改善患者症状,血栓消融程度高,损伤小,并发症少,但应严格掌握溶栓时机。Objective To explore the efficacy and safety of transcatheter thrombolysis therapy for pulmonary thromboembolism. Methods 65 patients with pulmonary thromboembolism were treated with transcatheter thrombolysis therapy; 57 patients had extremity deep venous thrombosis were implanted inferior vena eava filters through femoral or fight internal jugular vein, followed by pulmonary transcatheter thrombolysis. Pulmonary artefiography and lower extremity phlebography were performed before stopping thrombolysis therapy. All patients accepted long-term anticoagulation treatment by oral warfarin after operation. Vascular ultrasound and pulmonary 3D CTA were reexamined in 6 months after primary operation. Re- suits Successfidly implanted 57 filters with only one process, which consumed 2.2 rains. Filters displace extent was less than 2 mm and no tilt happened. All 65 patients accepted pulmonary transcatheter thrombolysis therapy, successful rate were 100%, average thrombolysis period 6.72 days. Before stopping thrombolysis therapy, dyspnceas in 55 patients disap- peared, 7 patients palliated, 1 patient aggravated. Thrombus were almost completely dissolved in 52 patients, were partial dissolved in 11 patients and were little dissolved in 1 patient. 1 patient confronted cerebral hemorrhage during thrombolysis. Thrombus in pulmonary artery and extremity venous did not aggravate and no clinical manifestation of pulmonary embolism and inferior vena cava occlusion emerged during follow-up of 6 months. Conclusions Filters implantation and pulmonary transcatheter thrombolysis for pulmonary thromboembolism have advantages of obvious and quick symptom improvement, high successful rate, low thrombus residual rate, little injure and good safe, but the time of operation should be cared.

关 键 词：腔静脉滤器 溶栓 肺动脉血栓栓塞 

分 类 号：R563.5[医药卫生—呼吸系统]