经导管接触溶栓治疗中危急性肺栓塞的有效性及安全性  

Efficacy and safety of catheter-directed thrombolysis in the treatment of intermediate-risk pulmonary embolism

作　　者：张兴华 严海涛 刘圣[1] 祖庆泉[1] 施海彬[1] Zhang Xinghua;Yan Haitao;Liu Sheng;Zu Qingquan;Shi Haibin(Department of Interventional Radiology,The First Afiliated Hospital of Nanjing Medical University,Jiangsu Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院介入放射科,江苏南京210029

出　　处：《中华介入放射学电子杂志》2025年第1期30-34,共5页Chinese Journal of Interventional Radiology:electronic edition

基　　金：江苏省科教能力提升工程(JSDW202243)。

摘　　要：目的探讨导管接触溶栓(catheter-directed thrombolysis,CDT)在治疗中危急肺栓塞(acute pulmonary embolism,APE)患者中的安全性与有效性。方法回顾性收集2021年1月至2023年9月在南京医科大学第一附属医院接受CDT治疗的46例中危APE患者的临床资料,其有效性主要指标为基线至术后7 d右心室/左心室比值(right ventricle/left ventricle,RV/LV)的下降值,次要指标包括Qanadli指数计算的血栓负荷量、肺动脉收缩压、氨基末端B型利钠肽前体(N-terminal probrain natriuretic peptide,NT-proBNP)及肌钙蛋白T;安全性评价包括住院期间的大出血事件发生率、非大出血事件发生率及术后3个月的复发率。结果CDT治疗24 h后心率由(93.5±11.6)次/min下降到(82.4±6.9)次/min,呼吸频率由(20.6±3.0)次/min降至(17.6±11.5)次/min,同时NTproBNP、肌钙蛋白T均有明显下降[1224.9(297.0,3652.5)ng/L vs 339.9(99.1,1515.0)ng/L;25.4(13.4,60.7)ng/L vs 17.3(10.3,30.7)ng/L],差异均有统计学意义(P<0.001)。CDT治疗7 d RV/LV值由(1.5±0.2)下降到(0.9±0.1),Qanadli指数计算的血栓负荷量由(49.1%±11.6%)减少到(16.7%±9.3%),差异均有统计学意义(P<0.001);肺动脉收缩压也有明显的下降[(51.0±10.6)mmHg vs(32.1±8.1)mmHg,P<0.001];NT-proBNP、肌钙蛋白T均有了更明显的下降(P<0.001)。住院期间所有患者均未发生大出血事件。有6例(13.0%)患者发生了非大出血事件。在后续3个月的随访中,有3例(6.5%)患者肺动脉血栓复发,10例(21.7%)患者残余少许血栓。结论经CDT治疗中危APE患者能够在较短时间内快速改善右心功能并减少血栓负荷,且安全性可接受。Objective To investigate the safety and efficacy of catheter-directed thrombolysis(CDT)in the treatment of intermediate-risk acute pulmonary embolism(APE)patients.Methods From January 2021 to September 2023,clinical data of 46 intermediate-risk APE patients who received CDT were retrospectively collected.The primary efficacy endpoint was the reduction in the right ventricle/left ventricle(RV/LV)ratio from baseline to 7 days post-procedure.The secondary efficacy endpoint included thrombus burden calculated by the Qanadli index,pulmonary artery systolic pressure,N-terminal pro-brain natriuretic peptide(NT-proBNP),and cardiac troponin T levels.Safety evaluation included major bleeding and clinically relevant nonmajor bleeding defined by the Bleeding Academic Research Consortium(BARC)criteria.Paired sample t-tests and Wilcoxon signed-rank tests were employed to assess the safety and efficacy of CDT in APE patients by comparing initial and post-treatment indicators.Results After 24 hours of CDT treatment,heart rate decreased from 93.5±11.6 to 82.4±6.9 beats/min(P<0.001),respiratory rate decreased from 20.6±3.0 to 17.6±11.5 breaths/min(P<0.001),and there was a significant decrease in NT-proBNP and troponin T[1224.9 ng/L(297.0,3652.5)vs 339.9 ng/L(99.1,1515.0),P=0.005 and 25.4 ng/L(13.4,60.7)vs 17.3 ng/L(10.3,30.7),P=0.029].The RV/LV ratio decreased from 1.5±0.2 to 0.9±0.1(P<0.001)after 7 days post-CDT.Simultaneously,the Qanadli index decreased from 49.1%±11.6%to 16.7%±9.3%(P<0.001).Significant reductions were observed in pulmonary artery systolic pressure[(51.0±10.6)mmHg vs(32.1±8.1)mmHg,P<0.001].NT-proBNP and troponin T both decreased more significantly(P<0.001).During hospitalization,no major bleeding events occurred in any of the patients.Six patients(13.0%)experienced non-major bleeding events.During the subsequent 3-month follow-up,3 patients(6.5%)experienced recurrent pulmonary embolism,and 10 patients(21.7%)had residual small amounts of thrombus.Conclusion The use of CDT in the treatment of intermediat

关 键 词：肺栓塞 导管接触溶栓术 右心室/左心室比值 

分 类 号：R563.5[医药卫生—呼吸系统]