肺动脉血栓切除术治疗急性危重肺动脉栓塞症——单中心45例报告  

Pulmonary thrombectomy for acute severe pulmonary embolism:a report of 45 cases

作　　者：王伟 王学锋 王咏 肖颖彬 WANG Wei;WANG Xue-feng;WANG Yong;XIAO Ying-bin(Cardiovascular surgery,Second Affiliated Hospital of Military Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院心血管外科,重庆市400037

出　　处：《中国心血管病研究》2019年第11期975-978,共4页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金面上项目(81770248)。

摘　　要：目的探讨肺动脉血栓切除术在急性危重肺动脉栓塞症(pulmonary embolism,PE)治疗中的作用.方法收集我院2010年1月至2018年12月行肺动脉血栓切除术的45例急性危重PE患者的临床资料,比较患者术前、术后及随访期间的超声心动图右心室直径、右心房直径、三尖瓣反流压差、肺动脉直径,比较术前、术后的动脉血氧分压(arterial partial pressure of oxygen,PaO2)、动脉血氧饱和度(arterial oxygen saturation,SaO2).结果45例急性危重PE患者中,3例术前心脏骤停的患者术后因严重缺血缺氧性脑病、多器官功能衰竭死亡或放弃治疗.其余42例患者均生存,随访期间无死亡病例(生存率93.3%,中位随访时间32个月).术后患者的PaO2[(86.9±7.5)mm Hg比(61.3±5.3)mm Hg]、SaO2[(96.9±2.7)%比(86.3±3.1)%]均高于术前(P<0.05);术后、随访期间末次超声的右心房直径、右心室直径、三尖瓣反流压差、肺动脉直径均较术前明显减小(P<0.05).结论对于急性危重PE患者,肺动脉血栓切除术是一种安全的手术方式,病死率低,可显著改善患者右心室功能及肺动脉压力,中远期效果良好.对于大面积PE的危重患者,应该更为积极的考虑进行肺动脉血栓切除术.Objective To investigate the role o f pulmonary thrombectomy in the treatment of acute severe pulmonary embolism(P E).Methods The clinical data of 45 patients with acute severe PE who underwent pulmonary thrombectomy in our hospital from January 2010-December 2018 were collected.The right ventricular diameter,right atrial diameter,tricuspid regurgitation pressure difference and pulmonary artery diameter were compared before and after the operation and during follow-up.The arterial partial pressure of oxygen(P a02)and arterial oxygen saturation(Sa〇2)were compared before and after the operation.Results Among 45 patients,3 patients with preoperative cardiac arrest died o f severe ischemic-hypoxic encephalopathy and multiple organ failure or gave up treatment after the operation.The remaining 42 patients survived and there were no deaths during follow-up(survival rate was 93.3%,median follow-up time was 32 months).PaO2[(86.9±7.5)mm Hg vs.(61.3±5.3)m m Hg]and S a02[(96.9±2.7)%vs.(86.3±3.1)%]in patients after the operation were higher than those before the operation(P<0.05).The right ventricular diameter,right atrial diameter,tricuspid regurgitation pressure difference and pulmonary artery diameter decreased significantly after the operation and during the follow-up(P<0.05).Conclusion For patients with acute severe P E,pulmonary thrombectomy is a safe operation with low mortality rate,which can significantly improve the right ventricular function and pulmonary artery pressure and has a good long-term and medium-term effect.

关 键 词：肺动脉栓塞 血栓切除术 右心室功能 肺动脉压力 

分 类 号：R654.2[医药卫生—外科学]