肺动脉栓塞的腔内旋切消融术介入治疗

目的：探讨经导管肺动脉腔内旋切消融术介入治疗肺动脉栓塞的临床疗效。方法：经右侧股静脉穿刺，行选择性左、右肺动脉插管造影的右侧肺动脉栓塞4例，其中右肺动脉主干不规则充盈缺损1例，右肺动脉主干及右下肺动脉不规则充盈缺损2例、下肺动脉均不规则充盈缺损1例；双侧肺动脉多发性栓塞1例，造影见右肺动脉主干及左下肺动脉不规则充盈缺损。5例病人均行肺动脉血栓旋切消融术并于下腔静脉内肾静脉以下各放置滤器1只。结果：本组病例经导管行血栓旋切消融术，肺动脉栓塞明显好转，各栓塞肺动脉及其分支重新显示，患者术中临床症状即刻明显减轻，血气明显改善，血氧饱和度及PaO2明显回升，基本恢复正常。有3例患者出现轻微胸痛。结论：对肺动脉栓塞病人实施经导管肺动脉腔内旋切消融术疗效肯定、安全、有效，能延长患者生命，提高患者的生活质量。     

急性肺动脉栓塞16例分析

目的：加强基层临床医生对肺栓塞的认识,以提高肺栓塞的诊断率及治疗成功率。方法：对近2 a来在我院心血管病房住院的16例肺栓塞患者诊治过程进行综合分析。结果：16例患者中除1例猝死外余均疗效明显。结论：急性肺栓塞临床症状多种多样,医生只有对肺栓塞提高警惕,才能减少误诊率和提高成功率。     

导管介入治疗急性肺栓塞的临床疗效观察

目的观察经皮导管介入治疗急性肺栓塞的疗效。方法选择2003年1月-2009年6月收治的急性肺栓塞患者15例,采用经皮导管吸栓术、碎栓术及溶栓术治疗。溶栓术用局部灌注加即刻静脉注射尿激酶,总量100万U。溶栓后给予低分子肝素7～10d,口服华法林3～6个月。观察临床症状、体征改善情况、并发症、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 12例肺动脉完全开通,3例部分开通,显效率89%,有效率100%。mPAP从（41.07±6.97）mmHg降到（21.00±5.66）mmHg,PO2从（46.26±9.30）mmHg升到（79.49±8.04）mmHg,治疗前后差异有统计学意义（P〈0.05）。即刻临床症状明显改善,mPAP迅速降低11例。随访3～6个月,疗效持续,未见复发。结论介入治疗急性肺栓塞疗效显著,安全可行,对抢救危重患者、改善临床症状、维持血流动力学稳定有重要作用。     

腹膜透析合并急性肺动脉栓塞行介入溶栓治疗的护理

总结1例腹膜透析合并急性肺动脉栓塞行介入溶栓治疗患者的护理经验。护理要点：基于分层随访制度,早期识别居家腹膜透析患者急性肺动脉栓塞症状;及时启动救治团队,行规范化胸痛评估;术后优化抗凝管理,预防出血;早期康复功能锻炼,预防急性肺动脉栓塞复发;初步构建居家腹膜透析患者急性肺动脉栓塞预警方案。经过治疗和护理,患者病情好转,术后未发生出血、心脑血管并发症。出院后1次家庭访视和3次门诊随访,患者均恢复良好。     

介入治疗肺动脉栓塞1例报道

1　病例资料病人女 ,4 3岁 ,因右下肢外伤后肿痛二十余天加重 2d入院。多谱勒血流超声提示 :右股、静脉无血流信号 ,诊断为右下肢深静脉急性血栓形成 ,给予溶栓祛聚治疗。 2d后患者出现胸痛、阵发性咳嗽、咯痰、痰中有血丝 ,双肺呼吸音粗 ,未闻及 口罗音 ,右胸闻及胸膜摩擦音。急摄胸片示 :双肺纹理多 ,右下肺外带见小片状阴影 ,右肋膈角变钝 ,左肋膈角锐利 ,急做螺旋CT检查 ,右肺动脉干及左下肺动脉血栓形成 ,右下肺栓塞后改变 ,右侧胸腔积液。采用血栓捣碎术和真空吸引取栓术再辅以肺动脉局部溶栓的方法。1 1　经导管栓子祛除术 ,旋转…     

急性肺动脉栓塞29例的护理

目的探讨急性肺动脉栓塞的早期诊断方法和护理措施。方法回顾分析2004-05-2010-05急性肺动脉栓塞29例的诊治过程及护理经验。结果 29例急性肺动脉栓塞抢救成功26例,成功率89.7%,并发肺部感染12例,死亡3例。结论早期诊断急性肺动脉栓塞,及时采取抢救及护理措施是提高抢救成功率的关键。     

血管栓塞介入治疗脑动脉瘤临床疗效评价

目的探讨血管栓塞介入治疗对脑动脉瘤的治疗效果。方法从2015年1月~2016年1月我院脑外科脑动脉瘤患者中选择50例作为研究对象,随机分组为观察组和对照组各25例,对照组采用传统开颅手术进行治疗,观察组采用血管栓塞介入治疗方法。观察和比较两组患者的治疗有效率、治疗前后的MMP-2水平。结果 (1)与对照组(60%)对比,观察组治疗有效率(92%)明显更高,P0.05。(2)与对照组对比,治疗后观察组MMP-2水平明显更高,P0.05;与治疗前对比,治疗后两组MMP-2水平明显升高,P0.05。(3)与对照组对比,观察组平均手术时间、术后恢复时间明显更短,术中出血量明显更少,P0.05。结论血管栓塞介入治疗脑动脉瘤临床疗效显著,有利于减轻对患者的手术创伤,促进患者术后的康复,改善患者的预后情况,值得临床广泛应用以及推广。     

冠状动脉介入治疗急性冠状动脉综合征疗效分析

目的评价冠状动脉介入治疗急性冠状动脉综合征 ( ACS)的疗效和安全性。方法对冠状动脉血管狭窄 >90 %及完全闭塞性病变 ,根据造影结果选择合适的球囊扩张和支架置入术。结果 42例 5 1个血管段的 PTCA及支架置入术。急性心肌梗死梗死相关血管单纯 PTCA7例 ,8个血管段病变狭窄 <90 %直接置入支架。 42例 ACS患者共置入 5 5个支架 ,支架置入成功率 10 0 % ,支架置入后管腔残余狭窄程度 ( 0± 10 ) % ,病变成功率为 96.1% ( 49/5 1处 )。 2例因引导钢丝未通过 C型病变而失败 ,无一例死亡、急性心肌梗死、紧急冠脉搭桥、心包填塞等严重并发症 ,术后主要并发症为穿刺部位出血。术后随访 1～ 12月 7例再发心绞痛 ,1例因再狭窄行冠状动脉旁路搭桥术治疗 ,无症状及经造影证实靶血管通畅率为 82 .5 % ( 33/4 0例 )。结论 ACS患者早期冠状动脉介入治疗 ,血管重建可降低冠心病事件 ,介入治疗安全、有效 ,值得推广     

急性肺动脉栓塞3例的抢救与护理

对我院急性肺动脉栓塞（PE）3例的抢救与护理总结如下。     

肺动脉栓塞的腔内旋切消融术介入治疗

目的 :探讨经导管肺动脉腔内旋切消融术介入治疗肺动脉栓塞的临床疗效。方法 :经右侧股静脉穿刺 ,行选择性左、右肺动脉插管造影的右侧肺动脉栓塞 4例 ,其中右肺动脉主干不规则充盈缺损 1例 ,右肺动脉主干及右下肺动脉不规则充盈缺损 2例 ,右上、下肺动脉均不规则充盈缺损 1例 ;双侧肺动脉多发性栓塞 1例 ,造影见右肺动脉主干及左下肺动脉不规则充盈缺损。 5例病人均行肺动脉血栓旋切消融术并于下腔静脉内肾静脉以下各放置滤器 1只。结果 :本组病例经导管行血栓旋切消融术后 ,肺动脉栓塞明显好转 ,各栓塞肺动脉及其分支重新显示 ,患者术中临床症状即刻明显减轻 ,血气明显改善 ,血氧饱和度及PaO2 明显回升 ,基本恢复正常。有 3例患者出现轻微胸痛。结论 :对肺动脉栓塞病人实施经导管肺动脉腔内旋切消融术疗效肯定、安全、有效 ,能延长患者生命 ,提高患者的生活质量     

急性肺栓塞的影像诊断与介入治疗分析

目的:对影像诊断急性肺栓塞的应用价值以及介入治疗的效果展开研究。方法:从2017年5月-2019年5月我院收治的患者中随机拣选17例怀疑为急性肺栓塞的患者,所有患者均采取CT诊断,并接受介入治疗,观察CT诊断的准确率以及漏诊和误诊率,此外对比治疗前后的治疗效果。结果:肺动脉造影检查后准确率为100%,CT诊断后准确率94.8%,差异不显著,P>0.05。介入治疗后患者的疼痛评分明显降低,呼吸频率恢复正常,治疗前后差异显著,P<0.05。结论:急性肺栓塞疾病采取CT影响诊断后具有较高的诊断准确率,漏诊率以及误诊率较低,并且在介入治疗后能够有效改善疼痛反应以及各项临床指标,治疗价值较高。     

急性肺栓塞的腔内治疗效果观察

目的 观察急性肺栓塞的腔内治疗效果.方法 选择2009年1月至2011年6月我院收治的急性肺栓塞患者15例,采用经皮导管碎栓术及溶栓术治疗.局部灌注尿激酶,总量50万U;溶栓后给予低分子肝素钠7～10d,口服华法林钠3～6个月.观察临床症状和体征改善情况、并发症、平均肺动脉压（mPAP）与动脉血氧分压（PaO2）的变化,以及肺动脉开通情况.结果 12例肺动脉完全开通,3例部分开通,有效率100％（15/15）.mPAP较术前降低[（40.07±5.97）、（20.00±4.66） mmHg],PaO2明显升高[（50.26±9.30）、（80.49±9.04） mmHg],差异均有统计学意义（t值分别为-1.128和1.246,P均＜0.05）.随访3～6个月,疗效持续,未见复发.结论 急性肺栓塞介入治疗效果显著,安全可行.     

Massive pulmonary embolism

An otherwise healthy 48-year-old woman presented in respiratory extremis from massive pulmonary embolism and promptly arrested. She underwent open-chest cardiopulmonary resuscitation followed by portable partial cardiopulmonary bypass and embolectomy but could not be resuscitated. Massive pulmonary embolism is frequently a desperate situation, but aggressive therapy with thrombolysis or embolectomy (in patients with contraindications to thrombolysis) may be lifesaving.     

肺栓塞患者抗凝治疗的急救护理

对肺栓塞患者的急救和抗凝治疗的配合及护理特点进行探讨。介绍了肺栓塞的急救护理措施、抗凝治疗的观察要点及护理对策,肯定了密切观察心电图、血压．呼吸及血氧饱和度与抗凝治疗中的护理配合和做好出院指导的重要性。     

急性肢体动脉栓塞的综合介入治疗效果分析

目的 探讨介入综合治疗对急性肢体动脉栓塞的疗效.方法 对38例急性肢体动脉栓塞患者(43条患肢)采用经皮导管球囊动脉成形术或支架植入术进行介入治疗,术后除1例转外科行Fogarty导管取栓术外,其余病例均予持续导管接触性溶栓及抗凝、扩血管、祛聚、改善微循环等辅助治疗.结果 介入治疗技术成功率100%;37条(86.05%)患肢治疗有效,其中痊愈29条(67.44%),7条(16.28%)疗效良好,1条(2.33%)疗效一般;4条(9.30%)患肢截趾或低位截肢;2例患者死亡(5.26%).随访1～32个月,3例患者3个月内再发肢体动脉栓塞,再行介入治疗后痊愈出院,其余病例均未再发栓塞.结论 综合介入治疗可明显改善急性肢体动脉栓塞患者的致残率和致死率,有效降低再栓塞风险.     

Thrombolytic therapy and outcome of patients with an acute symptomatic pulmonary embolism

Background:  While the primary therapy for most patients with a pulmonary embolism (PE) consists of anticoagulation, the efficacy of thrombolysis relative to standard therapy remains unclear. Methods:  In this retrospective cohort study of 15 944 patients with an objectively confirmed symptomatic acute PE, identified from the multicenter, international, prospective, Registro Informatizado de la Enfermedad TromboEmbólica (RIETE registry), we aimed to assess the association between thrombolytic therapy and all‐cause mortality during the first 3 months after the diagnosis of a PE. After creating two subgroups, stratified by systolic blood pressure (SBP) (< 100 mm Hg vs. other), we used propensity score‐matching for a comparison of patients who received thrombolysis to those who did not in each subgroup. Results:  Patients who received thrombolysis were younger, had fewer comorbid diseases and more signs of clinical severity compared with those who did not receive it. In the subgroup with systolic hypotension, analysis of propensity score‐matched pairs (n = 94 pairs) showed a non‐statistically significant but clinically relevant lower risk of death for thrombolysis compared with no thrombolysis (odds ratio [OR] 0.72; 95% confidence interval [CI], 0.36–1.46; P = 0.37). In the normotensive subgroup, analysis of propensity score‐matched pairs (n = 217 pairs) showed a statistically significant and clinically meaningful increased risk of death for thrombolysis compared with no thrombolysis (OR 2.32; 95% CI, 1.15–4.68; P = 0.018). When we imputed data for missing values for echocardiography and troponin tests in the group of normotensive patients, we no longer detected the increased risk of death associated with thrombolytic therapy. Conclusions:  In normotensive patients with acute symptomatic PE, thrombolytic therapy is associated with a higher risk of death than no thrombolytic therapy. In hemodynamically unstable patients, thrombolytic therapy is possibly associated with a lower risk of death than no thrombolytic therapy. However, study design limitations do not imply a causal relationship between thrombolytics and outcome.     

老年人群发生急性肺栓塞的相关危险因素

目的：探讨老年人群发生急性肺栓塞(APE)的相关危险因素。方法回顾我院收治的105例 APE 患者临床资料,按年龄分为老年组55例和非老年组50例,比较两组临床表现,分析老年人 APE 危险因素。结果非老年组和老年组的呼吸困难、咳嗽、胸闷的发生率分别为82.0%(41/50)vs 85.5%(47/55)、70.0%(35/50)vs 78.5%(43/55)、62.0%(31/50)vs 52.7%(29/55)(均 P >0.05)。老年组的危险因素有慢性阻塞性肺疾病病史、心脑血管病史、糖尿病病史;非老年组的危险因素有深静脉血栓史、外伤及手术史。结论老年组 APE 患者的临床表现多不典型,与非老年组相似,老年组发生 APE 的危险因素与非老年组不同,临床上应密切注意。     

Safety of outpatient treatment in acute pulmonary embolism

See also Baglin T. Fifty per cent of patients with pulmonary embolism can be treated as outpatients. This issue, pp 2404–5; Kovacs MJ, Hawel JD, Rekman JF, Lazo‐Langner A. Ambulatory management of pulmonary embolism: a pragmatic evaluation. This issue, pp 2406–11. Summary. Introduction: Data regarding outpatient treatment of pulmonary embolism (PE) is scarce. This study evaluates the safety of outpatient management of acute PE. Methods: This is a retrospective cohort study of consecutive patients presenting at the Ottawa Hospital with acute PE diagnosed between 1 January 2007 and 31 December 2008. PE was defined as an arterial filling defect on CTPA or a high probability V/Q scan. Patients were managed as outpatients if they were hemodynamically stable, did not require supplemental oxygenation and did not have contraindications to low‐molecular‐weight heparin therapy. Results: In this cohort of 473 patients with acute PE, 260 (55.0%) were treated as outpatients and 213 (45.0%) were admitted to the hospital. The majority of the patients were admitted because of severe comorbidities (45.5%) or hypoxia (22.1%). No outpatient died of fatal PE during the 3‐month follow‐up period. At the end of follow‐up, the overall mortality was 5.0% (95% CI, 2.7–8.4%). The rates of recurrent venous thromboembolism (VTE) in outpatients were 0.4% (95% CI, 0.0–2.1%) and 3.8% (95% CI, 1.9–7.0%) within 14 days and 3 months, respectively. The rates of major bleeding episodes were 0% (95% CI, 0–1.4%) and 1.5% (95% CI, 0.4–3.9%) within 14 days and 3 months, respectively. Four (1.5%) outpatients were admitted to the hospital within 14 days. Conclusions: A majority of patients with acute PE can be managed as outpatients with a low risk of mortality, recurrent VTE and major bleeding episodes.     

家兔急性肺栓塞影像模型的制备

目的:通过家兔急性肺栓塞影像模型的制备并与DSA和MRPA及病理对照研究,验证用明胶海绵制作家兔肺栓塞影像模型的可行性和准确性。方法:在DSA下经家兔颈静脉插管至右心房,将明胶海绵自导管注入,栓塞前后分别做肺动脉造影和增强磁共振肺动脉成像,最后经病理解剖来验证肺栓塞模型的可靠性。结果:在MRPA和DSAPA图像上,肺栓塞表现为肺动脉分支截断?熏 病理镜下可见肺动脉管腔内有明胶海绵栓塞物。结论:此方法制备肺栓塞模型是客观有效的,为肺栓塞的影像学研究提供了一种较好的方法。     

Circulatory failure in acute pulmonary embolism

Circulatory failure occurs in about 10% of patients with pulmonary embolism, resulting from a massive obstruction of the pulmonary arterial bed. Hemodynamic and respiratory features are well established; they involve precapillary pulmonary hypertension, low cardiac output state, elevated filling pressure for the right ventricle, and venous admixture. More recently, two-dimensional echocardiography permitted the visualization of pulmonary artery and right heart enlargement, reduced right ventricular ejection fraction, and tricuspid regurgitation. Evaluated by this latter means, left ventricular systolic function appeared unchanged, but diastolic function might be reduced by septal bulging.