CAJ | 학술논문

目的总结急性肺动脉栓塞的介入治疗经验,提高其疗效和安全性.方法回顾性分析2009年6月至2011年5月收治的15例急性肺动脉栓塞患者的临床资料,所有患者均有急性下肢深静脉血栓,先行下腔静脉滤器置入术,其后5例肺动脉主干栓塞者行肺动脉碎栓吸栓及置管溶栓,10例肺动脉分支栓塞者于髂股静脉内置入溶栓导管行外周及肺动脉同时溶栓,术后观察临床症状改善情况、并发症、Miller指数、平均肺动脉压(mPAP)与动脉血氧分压(PO2)的变化,以及肺动脉开通情况.结果 5例肺动脉主干栓塞者主干血管完全开通,症状即刻缓解,Miller指数从(0.51±0.04)降至(0.27 ±0.38),mPAP从(55.3±3.1) mmHg降至(32.7 ±2.2) mmHg,PO2从(40±3) mm Hg上升到(63±4) mm Hg,治疗前后差异有统计学意义(P＜0.01).10例外周导管溶栓患者栓塞的分支肺动脉部分开通,髂股静脉的血栓大部分被清除,临床症状明显缓解,术后均给予溶栓、抗凝、抗血小板聚集等治疗.本组随访13例,随访3 ～12个月,平均(8±3)个月,疗效持续,未见复发.结论急诊肺动脉介入治疗能迅速改善急性肺栓塞肺循环梗阻状况,减轻临床症状,疗效显著,安全可行.
목적 총결급성폐동맥전새적개입치료경험,제고기료효화안전성.방법 회고성분석2009년6월지2011년5월수치적15례급성폐동맥전새환자적림상자료,소유환자균유급성하지심정맥혈전,선행하강정맥려기치입술,기후5례폐동맥주간전새자행폐동맥쇄전흡전급치관용전,10례폐동맥분지전새자우가고정맥내치입용전도관행외주급폐동맥동시용전,술후관찰림상증상개선정황、병발증、Miller지수、평균폐동맥압(mPAP)여동맥혈양분압(PO2)적변화,이급폐동맥개통정황.결과 5례폐동맥주간전새자주간혈관완전개통,증상즉각완해,Miller지수종(0.51±0.04)강지(0.27 ±0.38),mPAP종(55.3±3.1) mmHg강지(32.7 ±2.2) mmHg,PO2종(40±3) mm Hg상승도(63±4) mm Hg,치료전후차이유통계학의의(P＜0.01).10예외주도관용전환자전새적분지폐동맥부분개통,가고정맥적혈전대부분피청제,림상증상명현완해,술후균급여용전、항응、항혈소판취집등치료.본조수방13례,수방3 ～12개월,평균(8±3)개월,료효지속,미견복발.결론 급진폐동맥개입치료능신속개선급성폐전새폐순배경조상황,감경림상증상,료효현저,안전가행.
Objective To summarize the experience on treatment for 15 cases of acute pulmonary embolism(PE).Methods Fifteen acute PE patients admitted from June 2009 to May 2011 were analyzed retrospectively.All patients were diagnosed as PE and deep vein thrombosis,and treated with placement of inferior vena caval filters(IVC).Five patients with main pulmonary artery embolism accepted intrapulmonary arterial interventional therapy of thrombus fragmenlation and suction and catheter-directed thrombolysis (CDT).Ten patients with embolization on pulmonary artery branch and acute iliofemoral vein thrombus accepted therapy of peripheral thrombolysis.During postoperative course improvement was observed on the clinical symptoms,occurrence of complications,Miller index,change of mean pulmonary arterial pressure (mPAP) and arterial partial pressure of oxygen(PO2),as well as the patency of pulmonary artery.Result Five main pulmonary artery embolization patients gained complete patency of pulmonsnary artery,and the clinical symptoms immediately improved.Miller index reduced from (0.51 ± 0.04) to (0.27 ± 0.38),mPAP decreased from (55.3 ± 3.1 ) mm Hg to ( 32.7 ± 2.2 ) mm Hg,and PO2 elevated from ( 40 ±3 ) mm Hg to ( 63 ± 4) mm Hg,showing a significant difference ( P ＜ 0.01 ).Ten patients with pulmonary artery branch embolization gained patency of pulmonary artery branch,iliofemoral venous thrombosis cleared,and clinical symptoms significantly improved.All patients recovered after two weeks of intravenous thrombolytic,anticoagulation and antiplatelet therapy.During three to twelve months' follow up,the therapeutic effects persisted and there was no recurrence.Conclusions Emergency intrapulmonary arterial interventional therapy of acute PE has remarkable effectiveness,safety and feasibility,improving pulmonary obstruction and clinical symptoms.