急性肺血栓栓塞症患者溶栓治疗后的远期预后分析

目的　分析急性大面积肺血栓栓塞症 (PTE)患者溶栓治疗后的远期预后。方法　对2 60例急性PTE患者进行溶栓治疗并随访 ,分析其临床资料及引起远期临床事件 [死亡、再发深静脉血栓形成、再发PTE、慢性血栓栓塞性肺动脉高压和 (或 )右心衰竭、抗凝治疗出现大出血、依赖家庭氧疗 ]的危险因素。结果　 2 60例PTE患者在住院期间死亡 2 2例 (8 5 % ) ,其中 1 5例 (62 8% )死于PTE。随访 2 2 7例患者 ,为期 3 9～ 8 4年 ,死亡 72例 (31 7% ) ,其中有 2 1例患者死于再发PTE。对随访资料完整的 1 65例患者进行远期临床事件的危险因素分析 ,单因素分析显示 ,既往有血栓栓塞病史、抗凝治疗不足 6个月、植入下腔静脉滤器、溶栓后超声心动图仍显示右室功能障碍和 (或 )扩大、溶栓后超声多普勒仍测得肺动脉收缩压 >50mmHg、出院前核素肺通气 /灌注扫描显示肺血管床阻塞 >30 %与远期临床事件的发生相关 ;多变量分析显示 ,溶栓后超声心动图仍显示右室功能障碍和 (或 )扩大、溶栓后超声多普勒仍测得肺动脉收缩压 >50mmHg、出院前核素肺通气 /灌注扫描显示肺血管床阻塞 >30 %是PTE远期预后的独立危险因素。结论　通过高危因素的确立 ,可予患者更积极的治疗 ,改善患者的预后

Long-term outcome of acute massive pulmonary thromboembolism following thrombolysis

Objective To evaluate in hospital course and long term outcome of acute massive pulmonary thromboembolism after thrombolysis and to determine its prognostic factors Methods A total of 260 patients was retrospectively reviewed and followed up for 3 9 8 4 years Close attention was paid to the clinical events, including death, recurrent thromboembolic events, chronic thromboembolic pulmonary hypertension, bleeding complications attributed to anticoagulant therapy, and requirement of oxygen therapy at home Kaplan Meier event free survival curves were generated Results The in hospital mortality rate was 8 5%, in which 68 2% were due to pulmonary thromboembolism itself, and the follow up mortality rate was 31 7%, in which 29 2% were due to recurrent embolism Univariate analysis showed that six variables were associated with the occurrence of clinical events: (1)Prior thromboembolic diseases; (2)Duration of anticoagulant therapy less than 6 months; (3)Inferior vena cava filter placement; (4)Remaining right ventricular dysfunction/dilatation after thrombolysis detected by echocardiography; (5)Systolic pulmonary pressure >50 mm Hg after thrombolysis by echocardiography; (6)Greater than 30% residual obstruction of pulmonary vasculature identified by lung ventilation/perfusion scintigraphy before hospital discharge Multivariate analysis identified three independent risk factors for long term mortality of acute massive pulmonary thromboembolism after thrombolysis: (1)Systolic pulmonary artery pressure >50 mm Hg ( RR: 3 78,95% CI=2 70 4 86); (2)Right ventricular dysfunction/dilatation ( RR :2 18,95% CI=1 48 2 88); (3)Greater than 30% obstruction of pulmonary vasculature ( RR :1 99,95% CI=1 25 2 70) Conclusions Doppler echocardiographic assessment after thrombolysis and ventilation/perfusion scintigraphy prior to hospital discharge are valuable to establish a new baseline condition,which is informative for risk stratification and prognostication of long term outcome