介入治疗急性中央型肺血栓栓塞疗效分析
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摘要
目的探讨介入治疗急性中央型肺血栓栓塞(PTE)的有效性及安全性。方法回顾性分析72例急性中央型PTE,均接受PTE介入治疗,其中65例患者合并下肢深静脉血栓,术中同时接受下肢深静脉血栓"一站式"介入治疗。观察术中及术后并发症情况。测量介入治疗后肺动脉压及D-二聚体水平,并与治疗前对照。术后随访评价治疗效果。结果无严重并发症发生,仅7例术中心律失常、血压升高,9例溶栓导管周围渗血,5例术后穿刺点皮下瘀斑,均经对症处理后好转。与PTE介入取栓、导管溶栓前相比,治疗后肺动脉压明显下降[(30.11±14.50)mmHg vs (40.22±17.58)mmHg,t=3.77,P<0.01],D-二聚体水平亦明显下降[(623.32±267.41)ng/ml vs (3 634.38±1 567.61)ng/ml,t=12.56,P<0.01)。术后平均随访(15.92±5.22)个月。72例PTE介入治疗总体有效率为97.22%(70/72);65例合并下肢深静脉血栓,治疗后下肢血栓完全清除或清除率≥95%(Ⅲ级)者占93.85%(61/65),50%≤血栓清除率<95%(Ⅱ级)者占6.15%(4/65)。结论通过介入手段可安全、有效地治疗急性中央型PTE,尤其是合并下肢深静脉血栓者。
Objective To explore the efficacy and safety of interventional therapy for acute central pulmonary thromboembolism(PTE). Methods Data of 72 patients with acute central PTE were retrospective analyzed. Interventional therapy of PTE were performed in all patients, then "one-stop" interventional therapy of deep venous thrombi of lower extremity were also performed in 65 patients. Complications during and after therapies were observed. Pulmonary artery pressure and D-dimer level were measured after interventional therapy and compared with those before treatment. The therapeutic effect was evaluated during follow-up. Results No serious complication occurred. Heart rate arrhythmia and blood pressure rise during operation happened in 7 patients, blood leakage around thrombolytic catheter and subcutaneous ecchymosis at puncture point after operation were observed in 9 and 5 patients, respectively, all relieved after symptomatic treatment. Pulmonary artery pressure decreased significantly after interventional thrombectomy combined with catheter thrombolysis([30.11±14.50]mmHg vs [40.22±17.58]mmHg, t=3.77, P<0.01), and D-dimer level also decreased significantly([623.32±267.41]ng/ml vs [3 634.38±1 567.61]ng/ml, t=12.56, P<0.01) compared with those before treatment. The mean follow-up time was(15.92±5.22) months, and the total effective rate of interventional therapy of PTE was 97.22%(70/72). Complete thrombosis clearance or clearance rate of lower extremity higher than or equal to 95%(grade Ⅲ) were observed in 61 patients(61/65, 93.85%) combined with PTE and deep venous thrombosis of lower extremities, while the rest 4 patients(4/65, 6.15%) had thrombosis clearance rate higher than or equal to 50% but lower than 95%(grade Ⅱ). Conclusion Interventional therapy is safe and effective in treatment of acute central PTE, especially for patients with lower extremity deep venous thrombosis.
Objective To explore the efficacy and safety of interventional therapy for acute central pulmonary thromboembolism(PTE). Methods Data of 72 patients with acute central PTE were retrospective analyzed. Interventional therapy of PTE were performed in all patients, then "one-stop" interventional therapy of deep venous thrombi of lower extremity were also performed in 65 patients. Complications during and after therapies were observed. Pulmonary artery pressure and D-dimer level were measured after interventional therapy and compared with those before treatment. The therapeutic effect was evaluated during follow-up. Results No serious complication occurred. Heart rate arrhythmia and blood pressure rise during operation happened in 7 patients, blood leakage around thrombolytic catheter and subcutaneous ecchymosis at puncture point after operation were observed in 9 and 5 patients, respectively, all relieved after symptomatic treatment. Pulmonary artery pressure decreased significantly after interventional thrombectomy combined with catheter thrombolysis([30.11±14.50]mmHg vs [40.22±17.58]mmHg, t=3.77, P<0.01), and D-dimer level also decreased significantly([623.32±267.41]ng/ml vs [3 634.38±1 567.61]ng/ml, t=12.56, P<0.01) compared with those before treatment. The mean follow-up time was(15.92±5.22) months, and the total effective rate of interventional therapy of PTE was 97.22%(70/72). Complete thrombosis clearance or clearance rate of lower extremity higher than or equal to 95%(grade Ⅲ) were observed in 61 patients(61/65, 93.85%) combined with PTE and deep venous thrombosis of lower extremities, while the rest 4 patients(4/65, 6.15%) had thrombosis clearance rate higher than or equal to 50% but lower than 95%(grade Ⅱ). Conclusion Interventional therapy is safe and effective in treatment of acute central PTE, especially for patients with lower extremity deep venous thrombosis.
引文
[1] 支立敏,张玉杰,曹大龙,等.急性肺栓塞45例临床诊治分析.中华全科学,2017,15(8):1286-1288.
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[10] 张青云,陈磊,丁萌,等.介入治疗在急性高危肺栓塞中的临床应用研究.临床放射学杂志,2016,35(11):1750-1753.
[11] 黄祥忠,郭新春,高峰,等.高危肺动脉栓塞的介入治疗.实用临床医药杂志,2017,21(05):115-117.
[12] 中华医学会心血管病分会肺血管病学组.急性肺动脉栓塞的诊断和治疗中国专家共识(2015).中华心血管病杂志,2016,44(3):197-211.
[13] Kearon C,Akl EA,Ornelas J,et al.Antithrombotic therapy for VTE disease:Chest guideline and expert panel report.Chest,2016,149(2):315-352.
[14] 中华医学会呼吸病学分会肺栓塞与肺血管病学组.肺血栓栓塞症诊治与预防指南(2018).中华医学杂志,2018,98(14):1060-1087.
[15] Kucher N.Catheter embolectomy for acute pulmonary embolism.Chest,2007,132(2):657-663.
[16] 蒋鹏,刘建龙,贾伟,等.下肢深静脉血栓脱落致肺栓塞45例临床研究.中国普外基础与临床杂志,2012,19(11):1179-1181.
[2] 李有霞,郑则广,刘妮,等.慢性阻塞性肺疾病急性加重伴肺动脉栓塞的危险因素分析.中华结核和呼吸杂志,2016,39(4):298-303.
[3] 朱亮,张希全,孙业全,等.急性全下肢深静脉血栓形成多种介入技术联合治疗.介入放射学杂志,2013,22(7):582-586.
[4] 中华医学会心血管病学分会肺血管病学组,中国医师协会心血管内科医师分会.急性肺血栓栓塞症诊断治疗中国专家共识.中华内科杂志,2010,49(1):74-81.
[5] O■uzkurt L,Ozkan U,Gulcan O,et a1.Endovascular treatment of acute and subacute iliofemoral deep venous thrombosis using manual aspiration thrombectomy:Long-term results of 139 patients in a single center.Diagn Interv Radiol,2012,18(4):410-416.
[6] Konstantinides SV,Torbicki A,Agnelli G,et al.2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism.Eur Heart J,2014,35(43):3033-3069.
[7] Stein PD,Kayali F,Olson RE.Trends in the use of diagnostic imaging in patients hospitalized with acute pulmonary embolism.Am J Cardiol,2004,93(10):1316-1317.
[8] Kearon C,Akl EA,Comerota AJ,et al.Antithrombotic therapy for VTE disease:Antithrombotic therapy and prevention of thrombosis,9th ed:American college of chest physiciana evidence-based clinical practice guidelines.Chest,2012,141(2 Suppl):e419S-e496S.
[9] 郝国强,魏立春,邢壮杰,等.肺动脉介入溶栓治疗急性肺栓塞的疗效分析.中国临床研究,2015,28(12):1618-1620.
[10] 张青云,陈磊,丁萌,等.介入治疗在急性高危肺栓塞中的临床应用研究.临床放射学杂志,2016,35(11):1750-1753.
[11] 黄祥忠,郭新春,高峰,等.高危肺动脉栓塞的介入治疗.实用临床医药杂志,2017,21(05):115-117.
[12] 中华医学会心血管病分会肺血管病学组.急性肺动脉栓塞的诊断和治疗中国专家共识(2015).中华心血管病杂志,2016,44(3):197-211.
[13] Kearon C,Akl EA,Ornelas J,et al.Antithrombotic therapy for VTE disease:Chest guideline and expert panel report.Chest,2016,149(2):315-352.
[14] 中华医学会呼吸病学分会肺栓塞与肺血管病学组.肺血栓栓塞症诊治与预防指南(2018).中华医学杂志,2018,98(14):1060-1087.
[15] Kucher N.Catheter embolectomy for acute pulmonary embolism.Chest,2007,132(2):657-663.
[16] 蒋鹏,刘建龙,贾伟,等.下肢深静脉血栓脱落致肺栓塞45例临床研究.中国普外基础与临床杂志,2012,19(11):1179-1181.