局部置管尿激酶灌注治疗肺动脉血栓栓塞的疗效观察  

Observation on the Efficacy of Local Transcatheter Urokinase Infusion for the Treatment of Pulmo-nary Thromboembolism

作　　者：杨昱[1] 吴文颖[2] 

机构地区：[1] 中国医科大学附属第一医院血管外科,辽宁 沈阳110001 [2]中国医科大学附属第一医院放射科,辽宁 沈阳110001

出　　处：《医学临床研究》2014年第1期10-13,共4页Journal of Clinical Research

摘　　要：[目的]探讨局部置管尿激酶灌注治疗肺动脉血栓栓塞的临床疗效及安全性。[方法]选择肺动脉置管尿激酶灌注治疗的肺栓塞患者78例，其中64例同时合并上肢或下肢静脉血栓形成，所有患者均行肺动脉置管尿激酶灌注治疗，治疗结束前复查肺动脉造影及下肢静脉造影，术后6个月复查血管超声及肺动脉双源CT三维血管成像（3DCTA）。[结果]置入腔静脉滤器64枚，均一次性释放成功，释放过程平均耗时2．1（1～6）min，释放过程中滤器弹跳幅度小于2mm，滤器无倾斜。78例患者均行肺动脉置管尿激酶灌注治疗，技术成功率100％，平均溶栓时间6．53d，75例呼吸困难患者治疗后86．7％（65/75）呼吸困难消失，12．0％（9/75）患者呼吸困难减轻，1．3％（1/75）患者呼吸、循环衰竭而死亡。血栓明显消融63例，血栓部分消融13例，血栓少量消融1例，1．3％（1/78）患者合并脑出血停用溶栓。随访期间肺动脉及肢体静脉血栓无明显增多。[结论]腔静脉滤器置入术及肺动脉置管尿激酶灌注治疗肺动脉血栓栓塞具有介入操作技术成功率较高、症状改善明显、血栓消融程度高、损伤小、安全性好的优点。[Objective] To explore clinical efficacy and safety of local transcatheter urokinase infusion for the treatment of pulmonary thromboembolism .[Methods] A total of 78 patients with pulmonary thromboembolism treated by pulmonary transcatheter urokinase infusion were chosen .Among them ,64 patients had extremity deep venous thrombosis simultaneously .Pulmonary transcatheter urokinase infusion was performed in all patients .Pul-monary arteriography and lower extremity phlebography were performed before stopping thrombolysis therapy . Vascular ultrasound and pulmonary 3DCTA were reexamined 6 months after the operation .[Results] The 64 vena cava filters were successfully implanted for one time .The mean releasing time was 2 .1mins （1~6mins） .Filter displace extent was less than 2mm .There was no tilt of filters .All 78 patients accepted pulmonary transcatheter urokinase infusion ,and the successful rate was 100% ,and the average thrombolysis duration was 6 .53 days（2~14 days） .After treatment ,86 .7% （65/75） patients had the disappearance of dyspnoeas ,and 12 .0% （9/75） pa-tients had the alleviation of dyspnoeas ,and 1 .3% （1/75） patients had respiratory and circulatory failure and died . Thrombus of 63 patients was dissolved obviously ,and that of 13 patients was dissolved partly ,and that of 1 pa-tient was little dissolved .There were 1 .3% （1/78） patients complicated with cerebral hemorrhage who stopped the thrombolysis .During the follow up ,thrombus in pulmonary artery and extremity vein had no obvious increasing .[Conclusion] Vena cava filter implantation and pulmonary transcatheter urokinase infusion for the treatment of pulmonary thromboembolism have advantages of obvious and quick symptom improvement , high thrombolysis rate ,little injury and good safety .The intervention procedure has high successful rate .

关 键 词：肺栓塞 药物疗法 尿纤溶酶原激活物 投药和剂量 

分 类 号：R563.5[医药卫生—呼吸系统]