介入治疗急性中央型肺血栓栓塞疗效分析  

Effect of interventional therapy for acute central pulmonary thromboembolism

作　　者：罗晓苗 公强 于凌 张希全[2] 陈众 王鑫[2] LUO Xiaomiao;GONG Qiang;YU Ling;ZHANG Xiquan;CHEN Zhong;WANG Xin(Imaging Center of Weifang Medical University,Weifang 261053,China;Interventional Treatment Center,People's Liberation Army,Zibo Branch of the 960th Hospital of Chinese People's Liberation Army,Zibo 255300,China)

机构地区：[1]潍坊医学院医学影像学系,山东潍坊261053 [2]中国人民解放军第960医院淄博院区全军腔内介入诊疗中心,山东淄博255300

出　　处：《中国介入影像与治疗学》2019年第7期400-404,共5页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的探讨介入治疗急性中央型肺血栓栓塞(PTE)的有效性及安全性。方法回顾性分析72例急性中央型PTE,均接受PTE介入治疗,其中65例患者合并下肢深静脉血栓,术中同时接受下肢深静脉血栓"一站式"介入治疗。观察术中及术后并发症情况。测量介入治疗后肺动脉压及D-二聚体水平,并与治疗前对照。术后随访评价治疗效果。结果无严重并发症发生,仅7例术中心律失常、血压升高,9例溶栓导管周围渗血,5例术后穿刺点皮下瘀斑,均经对症处理后好转。与PTE介入取栓、导管溶栓前相比,治疗后肺动脉压明显下降[(30.11±14.50)mmHgvs(40.22±17.58)mmHg,t=3.77,P<0.01],D-二聚体水平亦明显下降[(623.32±267.41)ng/mlvs(3634.38±1567.61)ng/ml,t=12.56,P<0.01)。术后平均随访(15.92±5.22)个月。72例PTE介入治疗总体有效率为97.22%(70/72);65例合并下肢深静脉血栓,治疗后下肢血栓完全清除或清除率≥95%(Ⅲ级)者占93.85%(61/65),50%≤血栓清除率<95%(Ⅱ级)者占6.15%(4/65)。结论通过介入手段可安全、有效地治疗急性中央型PTE,尤其是合并下肢深静脉血栓者。Objective To explore the efficacy and safety of interventional therapy for acute central pulmonary thromboembolism (PTE).Methods Data of 72 patients with acute central PTE were retrospective analyzed.Interventional therapy of PTE were performed in all patients,then "one-stop" interventional therapy of deep venous thrombi of lower extremity were also performed in 65 patients.Complications during and after therapies were observed.Pulmonary artery pressure and D-dimer level were measured after interventional therapy and compared with those before treatment.The therapeutic effect was evaluated during follow-up.Results No serious complication occurred.Heart rate arrhythmia and blood pressure rise during operation happened in 7 patients,blood leakage around thrombolytic catheter and subcutaneous ecchymosis at puncture point after operation were observed in 9 and 5 patients,respectively,all relieved after symptomatic treatment.Pulmonary artery pressure decreased significantly after interventional thrombectomy combined with catheter thrombolysis ([30.11±14.50]mmHg vs [40.22±17.58]mmHg,t =3.77,P <0.01),and D-dimer level also decreased significantly ([623.32±267.41]ng/ml vs [3 634.38±1 567.61]ng/ml,t =12.56,P <0.01) compared with those before treatment.The mean follow-up time was (15.92±5.22) months,and the total effective rate of interventional therapy of PTE was 97.22%(70/72).Complete thrombosis clearance or clearance rate of lower extremity higher than or equal to 95%(grade Ⅲ) were observed in 61 patients (61/65,93.85%) combined with PTE and deep venous thrombosis of lower extremities,while the rest 4 patients (4/65,6.15%) had thrombosis clearance rate higher than or equal to 50% but lower than 95%(grade Ⅱ).Conclusion Interventional therapy is safe and effective in treatment of acute central PTE,especially for patients with lower extremity deep venous thrombosis.

关 键 词：急性肺血栓栓塞 介入治疗 机械性取栓 导管溶栓 

分 类 号：R654.3[医药卫生—外科学] R814.4[医药卫生—临床医学]