肺血栓栓塞症介入与非介入两种方法治疗效果对比研究  

Contrastive study of the two treatment of Pulmonary thromboembolism Among the non intervention and Vascular intervention therapy

作　　者：许岭平 王璟 侯军龙 薛仙军 陈斌 马华 祁光裕[2] 陈剑辉 Xu Lingping;Wang Jing;Hou Junlong(Department of Cardiology,Xianyang Central Hospital of Shaanxi Province（Xianyang 712000)

机构地区：[1]陕西省咸阳市中心医院心血管二科,咸阳712000 [2]西安交通大学第一附属医院,西安710061

出　　处：《陕西医学杂志》2018年第6期763-766,共4页Shaanxi Medical Journal

摘　　要：目的:探讨急性重症肺血栓栓塞症介入治疗与非介入溶栓治疗两种方法的临床效果。方法:将66例肺血栓栓塞症患者分为介入组与非介入组,介入组30例行经皮穿刺肺动脉造影加选择性肺动脉溶栓、碎栓、血栓抽吸、球囊扩张术;非介入组36例行经右肘静脉溶栓治疗;两组患者肝素及华法林抗凝序贯治疗一致。对比两组患者各个时间段临床生命体征、氧和指数、实验室检查、症状改善情况,随访6月。结果:介入组与非介入组总有效率相比无统计学差异(P>0.05),恶化率及并发症相比两组无统计学差异(P>0.05)。非介入组操作简便性提高,临床缓解时间缩短(P<0.05)。结论:早期诊断、早期治疗是决定预后的关键。介入接触性溶栓,再灌注显效快,尤其循环衰竭者,效果突出。对于合并严重血流动力学的致命性肺血栓栓塞症可作为首选的第一时间治疗方案。非介入经右侧肘静脉溶栓安全性高,临床效果明确,避免有创操作,作为首选推荐。加强的抗凝序贯治疗可以明显降低肺血栓栓塞患者的病死率,改善预后。Objective：To comparison of the two treatment of pulmonary throm-boembolism among the vascular intervention therapy and non intervention.Analysis the therapeutic effect of two different methods.To explore the best treatment for severe acute pulmonary thromboembolism.Methods：From 66 patients with pulmonary thromboembolism were divided into the Vascular intervention therapy group and the non intervention group.The intervention group（n=30）underwent inferior vena cava filter placement,pulmonary artery angiography plus transcatheter thrombus fragmentation and thrombolytic therapy.The non intervention group（n =36）were for thrombolysis treatment through the right elbow vein.Two groups had same anticoagulation sequential treatmen of heparin and warfarin.Retrospective comparative variety of clinical symptoms,vital signs,oxygen and improve index,laboratory examination,follow-up treatment outcome in 6 months.The non intervention group has been more simple in operation,and even shorter in the time of clinical remission significantly.Results：There was no statistically significant difference between the intervention group and the non-intervention group（P〉0.05）,and the deterioration rate and complications were not statistically significant（P〉0.05）.The non-intervention group was improved with ease of operation,and the clinical relief time was shortened（P〈0.05）.Conclusion：Early diagnosis and early treatment is the key to determine prognosis.It is extra important that patients with circulatory failure be treated with interventional therapy.Fatal pulmonary thromboembolism with severe hemodynamics may be the first choice for treatment.The clinical effect of thrombolysis treatment through the right elbow vein is highly safety and prominent.For severe hemodynamic fatal pulmonary,thromboembolism through the right elbow vein can be used as the preferred solution in the first place.It is so safe,effective and avoiding invasive operation that should be recommend as the preferred.Strengthen the anticoagulat

关 键 词：肺栓塞/治疗 华法林/治疗应用 肝素/治疗应用 对比研究 @经皮肺动脉穿刺造影加选择性肺动脉溶栓 

分 类 号：R543.2[医药卫生—心血管疾病]