下腔静脉滤器预防肺栓塞及其并发症

目的探讨放置下腔静脉滤器在预防下肢深静脉血栓导致肺栓塞中的临床作用。方法74例下肢深静脉血栓形成患者(42例已经发生肺栓塞),为预防肺栓塞或再次肺栓塞而置入下腔静脉滤器,65例患者放置永久滤器,9例年轻患者放置可回收滤器。除8例有抗凝禁忌证患者外,其他患者行抗凝溶栓治疗。可回收滤器在放置后6~15天取出。随访观察有无滤器并发症、肺栓塞或复发肺栓塞出现。结果滤器均成功放置,患者未出现滤器错位、移位、倾斜、血栓脱落、滤器折断、腔静脉穿孔等并发症,随访期内未发现肺栓塞或复发肺栓塞,2例放置永久滤器的患者出现滤器血栓形成,1例放置可回收滤器的患者下腔静脉造影发现滤器血栓形成,其他8例可回收滤器取出后肉眼可见血栓,虽然造影没有发现。结论下腔静脉滤器作为预防肺栓塞的方法其效果值得肯定,但应该注意滤器血栓形成,在放置前选择合适的适应证。

Inferior vena cava filter placement in the prevention of pulmonary embolism and its complications

Objective To evaluate the clinical effect of prophylactic inferior vena cava filter (IVCF) placement in treatment of deep venous thrombosis (DVT) and prevention of fatal pulmonary embolism (PE). Methods Seventy-four patients with DVT (including 42 PE) were underwent percutaneous placement of IVCFs. 65 patients were placed permanent IVCFs and 9 young patients were placed retrievable IVCFs. Besides 8 patients who had a contraindication to anticoagulation, the other 66 patients were treated with anticoagulation and thrombolysis. The patients were followed up to monitor complications and recurrent PE. Results All the filters were placed in right position successfully and no detectable PE or recurrent PE was observed. 1 permanent filter thrombus and 2 retrievable filters thrombus were found, the other 8 retrievable filters thrombus were seen despite inferior vena-cavography were negative. Conclusion IVCF can prevent fatal pulmonary embolism effectively, but the filter thrombosis should be aware.