Study of clinical profile and management of patients with pulmonary embolism – Single center study

Objective

To study the clinical profile, diagnostic methods and management in patients with symptomatic pulmonary embolism (PE).

Methods

Retrospective assessment of clinical features and management of patients presenting with symptomatic pulmonary embolism from January 2005 to March 2012.

Results

35 patients who were newly diagnosed to have pulmonary embolism with a mean age of 52.1 years were included in the study. Dyspnea (91.4%) and syncope (22.8%) were the predominant symptoms. Echocardiography was done in all patients. 30 patients (85.7%) had pulmonary arterial hypertension, 31 patients (88.5%) had evidence of RV dysfunction and 4 patients (16.7%) had evidence of thrombus in PA, RV. Out of 35 patients, 34 patients (97.14%) showed positive d-dimer reports. Among 35 patients, 24 (68.5%) had positive troponin values. V/Q scan was done in 14 patients (40%) and CT pulmonary angiogram (CTPA) was done in 24 patients (68.5%.). Thrombolysis was done is 24 patients (68.5%). All patients received low molecular weight heparin followed by warfarin. Of the 35 patients, 34 (97.1%) were discharged and were under regular follow up for 6 months and one patient died during the hospital stay.

Conclusion

Pulmonary embolism is a common problem and can be easily diagnosed provided it is clinically suspected. Early diagnosis and aggressive management is the key to successful outcome.     

The central role of conventional 12-lead ECG for the assessment of microvascular obstruction after percutaneous myocardial revascularization

Guidelines report that the optimal treatment for ST-elevation myocardial infarction (STEMI) is a primary percutaneous coronary intervention (PPCI) when performed timely by trained operators. Yet, the reopening of the infarct-related artery (IRA) is not always followed by myocardial reperfusion. This phenomenon is most commonly called “no-reflow”, is caused by microvascular obstruction (MVO) and is associated to a worse outcome. Electrocardiogram (ECG) is crucial for the diagnosis of STEMI, but is also useful for the assessment of MVO. In this review we summarize ECG-derived parameters associated to MVO and their prognostic relevance.     

Intravenous thrombolysis for acute ischemic stroke

Intravenous thrombolysis (IVT) with alteplase remains the standard treatment for acute ischemic stroke. Although IVT can be started up to 4.5 hours after symptoms’ onset, it is all the more effective and safe when started early. It allows a 10% absolute reduction in the risk of handicap or death at 3 months, despite a 2–7% risk of symptomatic intracranial hemorrhage. Current research efforts involve firstly trying to treat a larger proportion of patients by overcoming some of the contraindications to IVT and secondly assessing combined or alternative treatments to achieve a higher early recanalization rate.     

持续灌注微泡并低强度超声介导体外血栓溶栓的实验研究

目的研究持续灌注微泡并低强度超声介导体外血栓的溶栓效果。方法构建体外循环系统,新鲜牛血栓随机分为5组。组1为低强度超声联合导管内持续灌注微泡和尿激酶进行溶栓;组2为低强度超声联合血栓内一次性注射微泡和尿激酶进行溶栓;组3为低强度超声联合导管内持续灌注尿激酶进行溶栓;组4为低强度超声联合导管内持续灌注微泡进行溶栓;对照组为导管内持续灌注尿激酶进行溶栓。统计分析各组的溶栓率和溶解面积,观察血栓内部红细胞分布情况及纤维蛋白网结构的完整性。结果组1溶栓率及溶栓面积均高于其他各组,差异均有统计学意义(P均<0.05);其他各组之间均无显著差异。该组HE染色镜下显示红细胞分布更松散,免疫荧光染色镜下可见较多纤维蛋白网结构断裂。结论在体外实验中,低强度超声联合持续灌注微泡能够增强尿激酶的溶栓效果。     

超早期选择性动脉内溶栓术治疗急性脑梗死的疗效分析

目的探讨超早期选择性动脉内溶栓治疗急性脑梗死的方法和疗效。方法经股动脉插管将微导管送入阻塞部位,给尿激酶75万U,0.9%氯化钠50ml,用微量泵以100ml/h的速度推注,注药前后造影观察血管再通情况。结果11例血管通率,67%,4周疗效基本痊愈：82%,显著进步：18%,显效率：100%。结论超早期溶栓能恢复血流灌注,可阻断脑梗死的病理过程,避免脑细胞的坏死,能明显提高治愈率,降低致残率。     

急性心肌梗塞溶栓疗效与脂蛋白（a）、血脂及纤溶指标的动态变化

观察２４例急性心肌梗塞（ＡＭＩ）患者的血清脂蛋白（ａ）［Ｌｐ（ａ）］动态变化及其与静脉法溶栓疗效关系。结果表明，ＡＭＩ患者的Ｌｐ（ａ）呈一过性升高，７～１４天达峰值，溶栓组比对照组峰值较快降至基线水平。Ｌｐ（ａ）浓度在溶栓不成功、住院期死亡或梗塞范围大的患者中增高更为明显，提示Ｌｐ（ａ）水平变化与ＡＭＩ溶栓疗效及急性期预后间可能有一定的联系。另外，还发现ＡＭＩ发病后早期组织型纤溶酶原激活物（ｔ－ＰＡ）活性及纤溶蛋白原溶解活性下降、纤溶酶原激活物抑制物（ＰＡＩ）活性升高；静脉滴注尿激酶或去纤酶后均可使ｔ－ＰＡ和纤溶活性升高，而且用药后第１～３天还使ＰＡＩ活性及纤维蛋白原含量明显降低，Ｌｐ（ａ）、血脂及纤溶指标相互之间相关性不甚明显。     

溶栓治疗对急性心肌梗塞患者早期心室晚电位的影响

本文评价溶栓治疗对急性心肌梗塞患者晚电位的影响。１８０例患者发病后５．９±３．４天描记晚电位。按溶栓与否分为：溶栓组５２例；非溶栓组１２８例。晚电位阳性发生率分别为１７．３％和３９．１％（Ｐ＜０．０５）；溶栓患者按冠状动脉再通间接指征分为再通组３１例，未再通组２１例，晚电位阳性发生率分别为６．５％和３３．３％（Ｐ＜０．０５）；冠状动脉造影１８例，按心肌梗塞溶栓治疗标准分为再通组１１例，未再通组７例，晚电位阳性发生率分别为９．１％和５７．１％（Ｐ＜０．０５），均有显著性差异。提示溶栓治疗可降低心肌梗塞晚电位阳性发生率，其作用机制与再灌注有关。     

尿激酶延迟溶栓治疗下肢深静脉血栓形成的安全性和有效性

目的：探讨尿激酶延迟溶栓疗法下肢深静脉血栓形成（ＬＥＤＶＴ）的安全性和有效性。方法：在静脉造影确诊后,采用尿激酶延迟溶栓疗法（５０万ｕ１０ｍｉｎ内推入,随后１ｈ内静脉输液１０万ｕ,２－３ｄ每天静脉输液１００万ｕ,４－１４ｄ每天静脉输液２５－５０万ｕ）加每天皮下注射肝素钙５０ｍｇ（每１２ｈ１次）和口服阿司匹林１００ｍｇ（每天１次）治疗ＬＥＤＶＴ患者９例,结果：血栓完全溶解１例（１１．１１％）,部分溶     

心肌呈色分级评价急性心肌梗死溶栓疗法的疗效

目的以心肌呈色分级(MBG)评估急性心肌梗死溶栓后的心肌灌注状况.方法89例急性心肌梗死患者给予重组组织型纤溶酶原激活剂治疗.各例于给药后90分钟行冠状动脉造影,观察梗死相关动脉前向血流,评估心肌灌注情况,并记录6个月心脏事件发生率.结果溶栓后符合临床再通标准的为87.6%,未再通的为12.4%.冠状动脉造影结果显示,全组梗死相关动脉的再通率(TIMI 2或3级)为82%;心肌再灌注率(MBG 2或3级)为88.8%,完全再通(TIMI 3级)且完全心肌再灌注(MBG 3级)者为40.4%.6个月死亡率为10.1%.多因素分析结果表明,入院时Killip分级和MBG分级是急性心肌梗死死亡的主要独立预测因子(P=0.0001).结论成功的再灌注治疗应该是梗死相关动脉前向血流TIMI 3级且伴良好心肌灌注.     

静脉溶栓治疗急性心肌梗死合并心源性休克观察与分析

目的旨在探讨静脉溶栓对急性心肌梗死并心源性休克近期预后的影响。方法1997年5月-2006年4月收住我院的发病12小时内入院合并心源性休克的急性心肌梗死患者。根据是否进行尿激酶静脉溶栓分为溶栓组与未溶栓组。分析两组患者的临床特征、处理与近期预后的异同。结果共44例患者入选,年龄39～80岁,平均(62.4±11.2)岁,其中男34例(占77.3%)。共有23例患者进行尿激酶静脉溶栓,21例患者未进行溶栓治疗。两组患者基本临床特征无显著差异。溶栓组患者死亡率显著低于未溶栓组(43.5%vs.76.2,P=0.027)。溶栓时血压恢复正常再灌注率明显高于血压低于90mmHg的患者(61.5%vs.20%,P=0.046)。结论合并心源性休克AMI患者,在积极改善血流动力学升高血压的同时,及时给予溶栓治疗,可以明显改善患者的近期预后。