血管腔内介入治疗急性肺动脉栓塞58例临床分析  

Clinical analysis of endovascular interventional therapy for acute pulmonary embolism in 58 patients

作　　者：张伟 谭永胜 王梁 石宝琪 Zhang Wei;Tan Yongsheng;Wang Liang;Shi Baoqi(Department of Interventional Diagnosis and Treatment,Inner Mongolia Autonomous Region People's Hospital,Hohhot 010017,Inner Mongolia Autonomous Region,China)

机构地区：[1]内蒙古自治区人民医院介入诊疗科,呼和浩特010017

出　　处：《中国基层医药》2024年第7期965-969,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨下腔静脉滤器置入联合导管定向溶栓、抗凝治疗急性肺动脉栓塞合并下肢深静脉血栓的疗效及安全性。方法采用病例对照研究, 回顾性分析内蒙古自治区人民医院2021年8月至2023年8月确诊的急性肺栓塞患者58例的临床资料, 根据是否合并下肢深静脉血栓分为两组, 单纯肺动脉栓塞组(单纯组, n=14)行经定向导管溶栓联合低分子肝素抗凝治疗;肺动脉栓塞合并下肢深静脉血栓组(合并组, n=44)行下腔静脉滤器置入联合定向导管溶栓及低分子肝素抗凝治疗。观察两组肺循环术前、术后改善情况, 比较两组肺动脉置管溶栓前后动脉血氧分压、指尖氧饱和度、肺动脉主干血栓/肺动脉主干面积占比和呼吸频率等指标改善情况。结果患者手术均成功, 呼吸急促症状均明显缓解。术后, 单纯组呼吸频率、平均肺动脉压、动脉血氧分压、指尖氧饱和度分别为(22.75±4.38)次/min、(32.53±3.63)mmHg(1 mmHg=0.133 kPa)、(81.46±7.24)mmHg、(90.53±4.57)%, 合并组分别为(23.35±5.8)次/min、(31.34±4.53)mmHg、(82.34±4.62)mmHg、(92.57±3.45)%, 两组均高于术前(t=6.33、12.12、17.32、8.13, 6.86、13.02、15.52、7.20, 均P<0.001);单纯组肺动脉主干血栓/肺动脉主干面积占比为(19.56±7.53)%, 合并组为(20.63±4.83)%, 两组较术前均缩小(t=19.36、18.23, 均P<0.001)。结论经导管定向溶栓联合下腔静脉滤器置入的手术方法对急性肺动脉栓塞合并下肢深静脉血栓的治疗是有效的, 且安全性高。Objective To investigate the efficacy and safety of combined catheter-directed thrombolysis and anticoagulation for acute pulmonary embolism combined with lower limb deep vein thrombosis.Methods A retrospective analysis was conducted using a case-control study approach on the clinical data of 58 patients with acute pulmonary embolism who received treatment at the Inner Mongolia Autonomous Region People's Hospital from August 2021 to August 2023.These patients were categorized into two groups based on whether they had lower-limb deep vein thrombosis or not.The group with pulmonary embolism alone(n=14)underwent targeted catheter thrombolysis in combination with anticoagulation treatment using low molecular-weight heparin.The group with both pulmonary embolism and deep vein thrombosis in the lower limbs(combined group,n=44)received inferior vena cava filter placement,along with targeted catheter thrombolysis and anticoagulation treatment with low-molecular weight heparin.The improvement in pulmonary circulation was observed before and after the surgical interventions in both groups.A comparison was made regarding the improvement in indicators including arterial oxygen pressure,fingertip oxygen saturation,the proportion of pulmonary artery trunk thrombosis area to pulmonary artery trunk area,and respiratory rate,both before and after pulmonary artery catheterization and thrombolysis in both groups.Results The surgery was successful for all patients.The symptom of shortness of breath was obviously relieved after surgery.After surgery,in the pulmonary embolism alone group,the respiratory rate was(22.75±4.38)beats/min,the mean pulmonary artery pressure was(32.53±3.63)mmHg(1 mmHg=0.133 kPa),the arterial oxygen partial pressure was(81.46±7.24)mmHg,and the fingertip oxygen saturation was(90.53±4.57)%,respectively.In the combined group,the respiratory rate,mean pulmonary artery pressure,arterial oxygen partial pressure,and fingertip oxygen saturation were(23.35±5.8)beats/min,(31.34±4.53)mmHg,(82.34±4.62)mmHg,and(92.5

关 键 词：肺栓塞 肺动脉瓣下狭窄 静脉血栓形成 机械溶栓 腔静脉滤器 抗凝药 治疗结果 

分 类 号：R563.5[医药卫生—呼吸系统]