经导管抽吸血栓联合接触性溶栓治疗急性中-高危与高危肺血栓栓塞  

Transcatheter thrombectomy combined with catheter-directed thrombolysis for treating acute medium-high and high risk pulmonary thromboembolism

作　　者：史键山 李艳芬 张名林 孙刚 金桂云[1] SHI Jianshan;LI Yanfen;ZHANG Minglin;SUN Gang;JIN Guiyun(Department of Interventional Vascular Surgery,The First Affiliated Hospital of Hainan Medical University,Haikou 570102,China;Department of Infectious Diseases,The First Affiliated Hospital of Hainan Medical University,Haikou 570102,China)

机构地区：[1]海南医学院第一附属医院介入血管外科,海南海口570102 [2]海南医学院第一附属医院感染科,海南海口570102

出　　处：《中国介入影像与治疗学》2024年第1期2-6,共5页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的观察经导管抽吸血栓联合接触性溶栓(CDT)治疗急性中-高危与高危肺血栓栓塞(PTE)的效果。方法对28例急性中-高危或高危PTE患者于置入下腔静脉滤器后行经导管抽吸血栓及CDT;观察治疗后临床症状有无改善,对比治疗前及治疗后72 h动脉血气分析、凝血功能、血常规、肺动脉压(PAP)及右心室直径/左心室直径(RV/LV)等,记录治疗相关并发症。随访观察治疗后1、3、6个月及1年PAP及肺动脉血栓清除效果。结果治疗后26例症状明显改善,2例死于呼吸衰竭。4例穿刺点出血,均经保守治疗后好转。相比治疗前,治疗后72 h,26例存活者血pH、动脉氧分压、血纤维蛋白降解产物及D-二聚体水平均升高,而心率、N-末端B型利钠肽原、PAP及RV/LV均下降(P均<0.05)。治疗后1、3、6个月及1年PAP均较治疗前降低,肺血栓清除率均较治疗前升高(P均<0.05);未见活动性出血及PTE复发。结论经导管抽吸血栓联合CDT可安全、有效地治疗急性中-高危与高危PTE。Objective To observe the effect of transcatheter thrombectomy combined with catheter-directed thrombolysis(CDT)for treating acute medium-high and high risk pulmonary thromboembolism(PTE).Methods After placement of inferior vena cava filter,transcatheter thrombectomy combined with CDT were performed in 28 patients with acute medium-high or high risk PTE.After treatment,clinical symptoms improved or not was assessed,and interventional related complications were recorded.The outcomes of arterial blood gas analysis,coagulation function,blood routine test,pulmonary artery pressure(PAP)and right ventricular diameter/left ventricular diameter(RV/LV)were compared before and 72 h after treatment.Regular follow-up was performed,then PAP and the clearance of pulmonary arterial thrombosis were observed 1,3,6 months and 1 year after treatment during follow-up.Results Among 28 cases,significant improvement of clinical symptoms achieved in 26 cases after treatment,while 2 patients died of respiratory failure.Puncture site bleeding occurred in 4 cases and improved after conservative treatment.Compared with those before treatment,among 26 survived patients,blood pH,arterial oxygen pressure,fibrin degradation products and D-dimer increased while the heart rate,N-terminal pro-B-type natriuretic peptide,PAP and RV/LV decreased 72 h after treatment(all P<0.05).During follow-up,compared with those before treatment,PAP decreased,while the clearance rate of pulmonary thrombosis increased 1,3,6 months and 1 year after treatment(all P<0.05).No active bleeding nor recurrence of PTE happened.Conclusion Transcatheter thrombectomy combined with CDT was safe and effective for treating acute medium-high and high risk PTE.

关 键 词：肺栓塞 溶栓疗法 

分 类 号：R563.5[医药卫生—呼吸系统] R815[医药卫生—内科学]