急性大面积肺动脉栓塞的介入治疗及疗效评价

目的 评价经血管栓子祛除术治疗急性大面积肺动脉栓塞的疗效和安全性.方法 对12例经CT肺血管造影或血管造影证实为大面积肺动脉栓塞患者,经肺动脉行传统介入器材碎栓、吸栓及局部溶栓联合治疗,观察临床症状、体征,血气分析及血流动力学改变,肺动脉开通情况以及有无并发症.结果 介入治疗后血管开通良好、症状即刻缓解9例,2例术后数天内症状逐步好转.PaO2术前(54.92±6.17)mmHg,术后达(90.91±1.62)mmHg,SaO2术前(85.17±8.39)%,术后达(95.75±1.96)%,差异有统计学意义(P均<0.01),休克指数明显下降(1.26±0.18/0.67±0.14,P<0.01),Miller评分明显降低(21.75±4.35/13.83±5.69,P=0.0001),mPAP显著下降[(35.59±7.68)mmHg/(30.04±7.93)mm Hg,P=0.001].1例因栓塞面积大,术后3 d死亡,术后并发脑出血1例,3 d后死亡.结论 经肺动脉行血管祛栓综合治疗急性大面积肺动脉栓塞是一种安全有效的方法 .     

急性大面积肺梗死的介入机械碎栓治疗

目的探讨急性大面积肺梗死介入机械碎栓治疗的可行性和临床疗效。方法对15例急性大面积肺栓塞患者采用碎栓器械行介入治疗,观察临床症状、肺动脉平均压、血氧分压和肺动脉开通情况。结果疗效评价为11例显效,3例好转,1例无效,术后动脉血氧分压明显升高,由(60.6±7.8)mmHg升至(91.0±7.7)mmHg,P=0.00;肺动脉平均压明显降低由(39.7±10.8)mmHg降至(27.3±7.9)mmHg,P=0.000。结论介入机械碎栓治疗急性大面积肺栓塞是一种可行且行之有效、安全的方法。     

介入螺旋电吸式祛栓术治疗急性大面积肺梗死

目的 评价用Straub螺旋电吸式祛栓术治疗急性大面积肺梗死的疗效和安全性.方法 5例患者经CT和肺动脉造影确诊为大面积肺血管栓塞.所有患者均有急性肺梗死的症状.采用Staub Rotarex对5例患者进行了经皮机械祛栓,1例使用了辅助局部溶栓.结果 所有患者在技术上和临床症状改善上均取得了成功.机械祛栓后患者的平均肺动脉压从(41.8±7.9)mmHg降低至(30.7±8.5)mmHg(P<0.01),动脉血氧分压(PaO2)从(56.6±9.3)mmHg增加至(85.8±5.0)mmHg(P<0.01).血氧饱和度(SaO2)从(79.0±4.3%)升至术后的(92.8±3.5)%(P<0.01).结论 初步经验显示Straub螺旋电吸式祛栓术在急性大面积肺梗死治疗中具有较好的安全性与疗效.     

血管内介入治疗急性肺栓塞疗效观察

目的:研究经皮血管内介入治疗肺栓塞的临床价值。方法:21例临床疑诊病例,经多层螺旋CT或心脏彩超诊断为大面积或次大面积肺栓塞后,立即接受经皮肺动脉内导管碎栓及溶栓治疗。观察肺循环和临床症状改善情况。18例同时合并有下肢深静脉血栓患者,溶栓治疗后放置下腔静脉滤器。结果:20例患者临床症状明显改善。1例改善不明显。治疗前平均肺动脉压(36±5)mmHg、动脉血氧分压(32±6)mmHg,溶栓治疗后分别为(20±3)mmHg、(66±4)mmHg,前后比较有统计学意义(P<0.05)。结论:血管内介入治疗急性大面积或次大面积肺栓塞安全、有效。     

单纯经皮机械祛栓治疗急性大面积肺栓塞的临床应用

目的评价单纯介入机械祛栓在治疗急性大面积肺栓塞(PE)方面的临床疗效和安全性。方法回顾性收集2003年1月到2008年1月经皮机械碎栓(PMT)或(和)Straub Rotarex系统祛栓治疗急性大面积PE病例6例。结果6例患者的肺动脉主干血流得以再通且临床症状改善。介入术后,患者SaO2从术前79.5%±5.3%增加至92.8%±3.4%(P<0.01);PaO2从术前从(58.0±9.8)mmHg增加至(88.7±4.1)mmHg(P<0.01);术后患者的平均肺动脉压(PAP)从(40.8±7.8)mmHg降至(29.8±8.0)mmHg(P<0.01);Miller指数从术前的0.54±0.03降至术后的0.18±0.07(P<0.01)。在完成临床随访的4例患者中,1～5年内均未有PE复发。结论初步临床经验显示单纯PMT是治疗急性大面积PE的一种简单、有效、安全的方法,尤其是针对有溶栓禁忌证的患者。     

静脉溶栓联合导管碎栓和切栓治疗急性大面积肺栓塞

目的评价静脉溶栓联合导管碎栓和切栓治疗急性大面积肺栓塞的临床疗效和安全性。方法对19例急性大面积肺栓塞患者，采用下腔静脉滤器置入、肺动脉导管碎栓和静脉溶栓加低分子肝素抗凝治疗，19例中4例加用了Straub Rotarex导管血栓旋切术。结果19例共行21次治疗。18例经介入治疗后胸闷、紫绀症状均明显改善，肺动脉中央分支血流恢复通畅，血氧饱和度由术前平均86％（74％～96％）上升到治疗后的平均97％（94％～100％）。肺动脉压力从术前的（334-5）mmHg（1mmHg=0．133kPa）下降到术后的（254-5）mmHg（t=13．2，P〈0．01）。l例双侧肺动脉主干大块血栓栓塞的患者，介入治疗无效，后经胸外科手术取栓未能成功，患者死亡。4例成功地采用了Straub Rotarex旋切治疗肺动脉血栓，未出现并发症。结论采用导管碎栓和血栓旋切等介入技术联合静脉溶栓抗凝治疗，是治疗急性大面积肺动脉栓塞的有效而且安全的方法。     

外科术后急性肺血栓栓塞症的介入治疗疗效

目的 探讨介入技术在治疗外科术后急性肺血栓栓塞中的临床疗效.方法 对11例外科术后急性肺血栓栓塞患者实施下腔静脉滤器植入术和经导管肺动脉取栓、溶栓治疗.结果 11例患者下腔静脉滤器均成功植入,介入治疗后临床症状明显改善,无严重并发症发生.结论 下腔静脉滤器植入和经导管肺动脉取栓、溶栓术治疗外科术后急性肺血栓栓塞安全微创,效果立竿见影.     

颅内血栓抽吸系统联合可视性取栓支架治疗颅内大动脉急性梗死5例北大核心CSCD

目的探讨Penumbra抽吸系统联合Trevo取栓器治疗颅内大动脉急性闭塞的临床效果。方法收集2016年11月至12月采用ACETM取栓器联合Trevo可视性取栓支架机械取栓治疗的5例颅内大动脉急性梗死患者临床资料。其中前循环闭塞2例,后循环闭塞3例;平均(60.4±11.6)岁。术后观察患者取栓时间、闭塞血管再通和神经功能恢复情况。结果 5例患者穿刺-血管再通时间分别为29 min、32 min、35 min、33 min、30 min,平均(31.8±2.4)min;术中脑梗死溶栓(TICI)治疗后血流分级均达到3级;NIHSS评分由术前(11.0±7.4)分明显改善至术后24 h(4.2±1.1)分、7 d(1.8±1.3)分、30 d(0.9±0.6)分(P<0.05);改良Rankin量表(m RS)评分均为0~2分,且未发生颅内出血转化。结论 ACETM取栓器联合Trevo取栓支架机械取栓治疗颅内大动脉急性梗死,在取栓次数少、取栓时间短情况下,取得了最佳血管再通效果,临床预后良好。     

介入机械性血栓清除术治疗急性肺栓塞

目的探讨应用介入机械性血栓清除术治疗急性肺栓塞的方法、疗效和安全性。方法对26例急性肺栓塞患者,行肺动脉造影明确栓子部位,应用机械血栓清除器械(Amplatz血栓消融器17例,Straub血栓旋切器9例)行介入血栓清除术,观察临床症状、肺动脉血栓清除情况、血氧饱和度(SaO2)、肺动脉平均压(MPAP)、动脉血氧分压(PaO2)。25例明确伴下肢深静脉血栓形成者,介入血栓清除术后放置下腔静脉滤器。结果本组均成功行介入机械性血栓清除术,26例患者介入术后临床症状均明显改善,SaO2明显上升,MPAP明显下降,PaO2明显升高,21例肺动脉内血栓大部分清除,无严重手术相关并发症。术后随访1～36个月,患者无肺动脉栓塞复发。结论介入机械性血栓清除术治疗急性肺栓塞是创伤小、安全易行、疗效确切的治疗方法。     

双能量CT评估急性肺栓塞治疗疗效

目的:探讨双能量CT在急性肺栓塞治疗疗效评估中的价值.方法:30例急性肺栓塞患者纳入本研究,所有患者在治疗前后均进行了双能量CT检查.比较治疗前后肺动脉栓子数目、肺动脉阻塞指数、右心室/左心室直径比值、肺动脉主干/升主动脉直径比值、双能量CT肺灌注缺损积分、全肺及左右肺的强化值和相对强化率.结果:30例患者中29例在治疗后肺动脉内栓子完全(n=18)或部分缓解(n=11),1例患者肺栓塞加重.双能量CT肺灌注成像显示治疗后5例患者无灌注缺损,25例患者有不同程度灌注缺损.30例患者治疗前后肺栓塞的位置、数目、肺动脉阻塞积分和双能量CT肺灌注缺损评分差异有统计学意义(P＜0.05),而肺动脉主干/同层面升主动脉直径比值、右心室/左心室直径比值、全肺及左右肺的强化值和相对强化率差异无统计学差别(P＞0.05).结论:双能量CT可用于急性肺栓塞治疗疗效的评估,可为临床治疗方案的制定及调整提供重要信息.     

Virtual pulmonary arterioscopy in pulmonary embolic disease

16 slice multidetector CT provides virtual endoscopic views of the inside of arteries, or any other hollow structures. This is performed non-invasively using post-processing of three-dimensional isotropic image data sets, acquired during standard CT examinations. These virtual endoscopic views are simultaneously correlated with the standard multiplanar reconstructions, with the ability to navigate a virtual camera through the hollow structure under study. Normal and abnormal volume rendered images of the pulmonary arteries are presented in correlation with the multiplanar reformats. The abnormal images show the volume rendered appearances of acute and chronic pulmonary embolic disease. It is also postulated that this technique has a problem solving role in the differential diagnosis of chronic mural emboli from extravascular structures such as adjacent lymph nodes or bronchiolar impaction. This technique may also have a role in medical education, providing clinicians and medical students with interactive three-dimensional representations of disease processes.     

The relationship between pulmonary artery pressure and pulmonary artery diameter in pulmonary hypertension

The pulmonary arteries dilate in response to many factors, principally increased pressure and flow. In patients who have pulmonary arterial hypertension but no increase in flow, we have compared main pulmonary artery size at computed tomography with pulmonary haemodynamic data obtained during right heart catheterisation. In patients with primary pulmonary hypertension and chronic thromboembolic pulmonary hypertension, dilatation correlated with raised pulmonary vascular resistance and reduced cardiac output but not with mean arterial pressure. In patients with chronic lung disease no correlations were shown though a trend between raised pressure and size was observed. We speculate that pulmonary artery compliance is an important factor which determines the degree of dilatation in response to raised pressure. Estimations of pressure cannot be made from measurements of pulmonary artery size without knowledge of the underlying lung disease.     

Computed tomography pulmonary angiogram diagnosis of pulmonary embolism

Over the last decade, contrast-enhanced spiral CT has been established as a non-invasive alternative to catheter angiography and is now regarded as the first-line imaging investigation for the diagnosis of pulmonary embolism (PE). The reported sensitivities for the diagnosis of PE of spiral CT vary from 45 to 100% and the specificities vary from 78 to 100%. Prospective outcome studies have shown a high negative predictive value for a single-detector spiral CT for PE. Patients' outcomes were not adversely affected in these studies when anticoagulation was withheld after a negative CT pulmonary angiogram. The main limitation of single-detector spiral CT has been its limited ability to detect isolated subsegmental PE. However, multidetector spiral CT allows evaluation of pulmonary vessels down to sixth-order branches and significantly increases the rate of detection of PE in segmental and subsegmental levels. The interobserver correlations for diagnosis of subsegmental PE with multidetector spiral CT exceed the reproducibility of selective pulmonary angiography. If appropriate equipment is available (multidetector CT), then CT pulmonary angiogram is safe to be used as the first-line imaging investigation for the diagnosis of PE.     

Unusual pulmonary angiographic findings in suspected pulmonary embolism

Pulmonary arteriography is most commonly performed to diagnose pulmonary embolism. A variety of clinical entities, however, may mimic pulmonary embolism both clinically and scintigraphically. Five patients with abnormal pulmonary arteriograms resulting from diseases other than pulmonary embolism are presented. The clinical, radiographic, and pathologic findings and long-term follow-up in these patients are described. Awareness of the angiographic patterns seen in these unusual cases is important in the differential diagnosis of pulmonary thromboembolism.     

CT-determined pulmonary artery diameters in predicting pulmonary hypertension

This study was to determine if the diameters of pulmonary arteries measured from computed tomographic (CT) scans could be used 1) as indicators of pulmonary artery hypertension and 2) as a reliable base for calculating mean pulmonary artery pressure. The diameters of the main, left, proximal right, distal right, interlobar, and left descending pulmonary arteries were measured from CT scans in 32 patients with cardiopulmonary disease and in 26 age- and sex-matched control subjects. Diameters were measured using a special computer program that could display a CT density profile of the artery and its adjacent tissues. The upper limit of normal diameter for the main pulmonary artery was found to be 28.6 mm (mean + 2 SD). In the patient group, the diameters were correlated with data from cardiac catheterization. In these patients, a diameter of the main pulmonary artery above 28.6 mm readily predicted the presence of pulmonary hypertension. The calculated cross-sectional areas of the main and interlobar pulmonary arteries (normalized for body surface area [BAS]) were found to give the best estimates of mean pulmonary artery pressure (r = 0.89, P less than 0.001 and r = 0.66, P less than 0.001). Multiple regression analysis gave the useful equation: mean pulmonary artery pressure = -10.92 + 0.07646 X area of main pulmonary artery/BSA + 0.08084 X area of the right interlobar pulmonary artery/BSA (r = 0.93, P less than 0.0001). Because CT allows precise, noninvasive measurement of the diameter of pulmonary arteries, it can be of value in detecting pulmonary hypertension and estimating mean pulmonary artery pressure.