CAJ | 학술논문

目的：探讨导管碎栓联合局部灌注瑞替普酶溶栓治疗高危肺动脉栓塞的疗效及安全性。方法高危肺动脉栓塞患者26例，经肺动脉内导管碎栓和局部灌注瑞替普酶溶栓治疗，观察处理前后肺循环改善情况，分析心肺血流动力学的改变。结果26例高危肺栓塞患者，术前平均肺动脉压、动脉血氧分压和血压分别为（63.78±6.89）mmHg、（73.23±11.51）mmHg 和（87.35±10.92）mmHg。术后分别为（26.23±10.27）mmHg、（93.48±6.17）mmHg和（127.14±13.15）mmHg，与治疗前比较差异均有统计学意义（P<0.01）。随访6～36个月，25例疗效持续，1例复发。结论肺动脉内导管碎栓联合局部灌注瑞替普酶溶栓治疗能迅速改善高危肺栓塞患者肺循环梗阻状况和临床症状，无明显并发症，对维持血流动力学稳定有很好作用。
목적：탐토도관쇄전연합국부관주서체보매용전치료고위폐동맥전새적료효급안전성。방법고위폐동맥전새환자26례，경폐동맥내도관쇄전화국부관주서체보매용전치료，관찰처리전후폐순배개선정황，분석심폐혈류동역학적개변。결과26례고위폐전새환자，술전평균폐동맥압、동맥혈양분압화혈압분별위（63.78±6.89）mmHg、（73.23±11.51）mmHg 화（87.35±10.92）mmHg。술후분별위（26.23±10.27）mmHg、（93.48±6.17）mmHg화（127.14±13.15）mmHg，여치료전비교차이균유통계학의의（P<0.01）。수방6～36개월，25례료효지속，1례복발。결론폐동맥내도관쇄전연합국부관주서체보매용전치료능신속개선고위폐전새환자폐순배경조상황화림상증상，무명현병발증，대유지혈류동역학은정유흔호작용。
Objective To evaluate the clinical effect and safety of transcatheter thrombus-breaking combined with local infusion of reteplase (rPA) in treating severe pulmonary thromboembolism (PTE). Methods During the period from June 2010 to June 2013 at authors’ hospital, transcatheter thrombus-breaking combined with local infusion of reteplase was carried out in 26 patients (17 males and 9 females) with severe pulmonary embolism. The changes of pulmonary circulation and the cardio - pulmonary hemodynamics after the treatment were analyzed. Results The preoperative mean pulmonary artery pressure, arterial blood oxygen partial pressure and the blood pressure were (63.78 ± 6.89) mmHg, (73.23 ± 11.51) mmHg and (87.35 ± 10.92) mmHg respectively, while the postoperative ones were (26.23 ± 10.27) mmHg, (93.48 ± 6.17) mmHg and(127.14 ± 13.15) mmHg respectively, and the differences between preoperative and postoperative ones were statistically significant (P<0.01). All the patients were followed up for 6 - 36 months. Significant stable clinical improvement was obtained in 25 patients, and recurrence was seen in one patient. Conclusion Transcatheter thrombus-breaking combined with local infusion of reteplase can quickly improve the pulmonary circulation and the clinical conditions for patients with severe pulmonary thromboembolism, and it has no obvious complications. This technique carries excellent value in maintaining the stability of hemodynamics.