肺动脉血栓栓塞26例临床诊断与介入治疗  

Clinical diagnosis and intervention therapy of pulmonary thromboembolism:a report of 26 cases

作　　者：马山[1] 任伟[1] 王莉[1] 夏东洲 郑如林 宋智军[1] 杨萍[1] 

机构地区：[1]甘肃省张掖市人民医院放射介入科,734000

出　　处：《中国临床研究》2013年第2期110-112,F0002,共4页Chinese Journal of Clinical Research

摘　　要：目的报告26例肺动脉血栓栓塞症(PTE)的临床诊断与介入治疗方法,评价介入技术治疗PTE的安全性和疗效。方法选择2009年10月至2012年6月行介入方法诊断及治疗的26例PTE患者,临床症状主要为胸痛、胸闷、气短、气促、咯血、休克等,其中7例有严重下肢静脉曲张并血栓形成,5例有深静脉血栓形成下肢肿胀。所有患者均进行心电图、超声心动图、64层螺旋CT肺动脉增强扫描,D-二聚体检查,合并下肢静脉曲张、深静脉血栓患者行下肢静脉造影。采用Seldinger穿刺法经右侧或左侧股静脉入路行肺动脉造影并留置导管溶栓,其中4例先采用导管捣碎、抽吸血栓的机械方法后留置导管溶栓。对7例严重下肢静脉曲张并血栓形成、5例深静脉血栓形成下肢肿胀患者留置导管溶栓前行临时下腔静脉滤器置入术。结果 26例患者经上述治疗,溶栓3～4d复查肺动脉造影,23例肺动脉内血栓被大部分清除、中央分支血流恢复,患者症状明显改善,血氧饱和度从术前平均82%增至94%;3例患者肺动脉造影有改善,但临床症状改善不明显,继续经留置导管抗凝治疗1周后患者临床症状消失,复查肺动脉造影显示主干及分支内血栓消失。所有患者无并发症发生。术后随访4～36个月,所有患者无复发。结论肺动脉造影并留置导管局部溶栓术治疗PTE起效快、疗效确切、并发症少。Objective Some aspects of clinical diagnosis and interventional treatment in 26 patients with pulmonary thromboembolism（PTE）are presented in this paper in order to evaluate the effectiveness and safety of interventional therapy for PTE. Methods Twenty-six patients received diagnosis and treatment by interventional method between October 2009 and June 2012 were included in this study. The clinical main symptoms include chest pain, chest tightness, shortness of breath, short breath, hemoptysis, shock, etc. Of 26 PTE patients, 7 accompanied varicose vein and thrombosis of lower limb,5 accompanied deep venous thrombosis（DVT） resulting in swelling of lower limb. The detections of electrocardiogram, echocardiogram, pulmonary arterial enhanced 64-shce spiral CT scans, D-dimer were all performed in 26 PTE patients, and venogram of lower limb was performed in patients with varicose vein of lower limb and DVT. Using seldinger puncture technique, the pulmonary angiography through left or right femoral vein route and indwelling catheter in the thrombolytic site were performed to conduct thromblysis. In 4 cases,the mechanical method of mashing and sucking out the thrombus was conducted at first, then indwelling catheter was performed for thrombolysis. In 7 cases of severe varicose vein and thrombosis and 5 cases of DVT leading to lower limb swelling, the temporary inferior vena cava filters were implanted before indwelling catheter for thrombolysis. Results Of 26 cases received mentioned treatment, 23 showed that the great part of thrombi in pulmonary artery were cleaned; the blood flow was recovered in central braches in pulmonary angiography during 3- 4 days check; clinical symptoms were improved; blood oxygen saturation increases from the preoperative average of 82% to 94% ;in 3 cases out of 26 cases, although pulmonary angiography improved yet the improvement of clinical symptoms was not obvious, and after I week of continuing coagulation therapy the clinical symptoms disappeared; pulmonary angiography check showe

关 键 词：肺动脉血栓栓塞 诊断 导管溶栓 机械碎栓 

分 类 号：R563.6[医药卫生—呼吸系统]