AngioJet血栓清除术补救溶栓失败的急性大面积肺栓塞初步临床研究  

Clinical study of AngioJet thrombectomy for rescue treatment of acute massive pulmonary embolism after unsuccessful thrombolysis: preliminary results

作　　者：公茂峰 顾建平[1] 楼文胜[1] 陈亮[1] 陈国平[1] 苏浩波[1] 何旭[1] Gong Maofeng;Gu Jianping;Lou Wensheng;Chen Liang;Chen Guoping;Su Haobo;He Xu(Department of Vascular and Interventional Radiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)介入血管科,210006

出　　处：《中华放射学杂志》2021年第8期865-870,共6页Chinese Journal of Radiology

基　　金：国家自然科学基金(81871463)。

摘　　要：目的初步探讨AngioJet药物机械偶联式血栓清除术(APMT)补救尿激酶(UK)溶栓失败的急性大面积肺栓塞(AMPE)患者的安全性和临床疗效。方法搜集2016年6月至2018年6月间南京医科大学附属南京医院介入血管科采用APMT后续补救UK治疗AMPE失败的患者16例的临床资料。对单独UK治疗失败患者予APMT辅助低剂量溶栓补救治疗。对心率(HR)、收缩压(SBP)、动脉血氧分压(PaO2)、肺动脉压(PAP)及肺动脉阻塞指数(CTOI)和补救安全性等方面进行评估。治疗前和治疗后计量资料采用配对样本t检验。结果16例患者均完成APMT操作,术后PAP较术前降低(P<0.05),辅助低剂量UK溶栓平均(3.25±1.78)d,溶栓结束时HR、SBP和PaO2较术前均明显改善(P<0.01)。治疗前CTOI为(26.81±14.86)%,经APMT辅助UK溶栓治疗后降为(11.56±3.26)%,差异具统计学意义(t=3.435,P<0.01),治疗后患者肺栓塞症状、体征均明显改善。APMT相关并发症包括2例心动过缓,2例胸部不适,2例血红蛋白尿,APMT治疗前后生化指标差异无统计学意义(P>0.05)。溶栓相关并发症中未见大出血事件发生,有2例小出血事件。结论UK溶栓失败的患者行APMT辅助低剂量溶栓继续治疗效果较好,可迅速减轻肺循环血栓负荷,改善PE临床症状、体征。Objective To evaluate the safety and clinical efficacy of AngioJet pharmacomechanical thrombectomy(APMT)in rescue treatment for patients with acute massive pulmonary embolism(AMPE)after unsuccessful thrombolysis with urokinase(UK).Methods From June 2016 to June 2018,the clinical data of 16 AMPE patients underwent APMT after unsuccessful thrombolysis with UK were collected.For these patients,the therapy was discontinued and replaced with APMT adjunctive low-dose thrombolysis with UK.Heart rate(HR),systolic blood pressure(SBP),arterial partial pressure of oxygen(PaO2),pulmonary artery pressure(PAP),CT obstruction index(CTOI)and therapy replacement safety were evaluated.The pared-samples t-test was used to analyze quantitative data before and after treatment.Results All 16 patients completed APMT procedure.PAP posterior was lower than prior treatment(P<0.05).The average adjunctive thrombolysis duration of UK was(3.25±1.78)d,HR,SPB,PaO2 after APMT were significantly improved(P<0.01).CTOI before and after APMT were(26.81±14.86)%and(11.56±3.26)%,respectively,and the difference was statistically significant(t=3.435,P<0.01).Symptoms and signs of pulmonary embolism were significantly improved after treatment.The complications associated with APMT occurred in 2 patients with bradyarrhythmia,2 patients with chest discomfort and 2 patients with hemoglobinuria.There were no statistically significant difference between the biochemistry indexes before and after APMT treatment(P>0.05).Moreover,no major bleeding occurred during thrombolysis procedure,and minor bleeding complications occurred only in two cases.Conclusions APMT adjunctive low-dose UK thrombolysis for rescue treatment of AMPE patients after unsuccessful thrombolysis with UK is relatively safe and effective.It can remove pulmonary artery thrombus rapidly,and improve clinical symptoms and signs of PE.

关 键 词：肺栓塞 尿激酶 经皮机械性血栓清除 

分 类 号：R563.5[医药卫生—呼吸系统]