急性肺动脉栓塞的介入治疗

目的探讨急性肺动脉栓塞的介入治疗效果。方法 2009年10月～2011年5月对19例急性肺动脉栓塞行下腔静脉滤器植入,肺动脉造影,导管碎栓、抽栓、溶栓治疗,其中12例术中应用球囊辅助碎栓,术后处理联合应用低分子肝素和华法林,调整凝血酶原国际标准化率在2～3。结果术中即刻造影显示8例主干完全开通,11例部分开通。术中16例肺动脉压下降至16～37 mm Hg,3例肺动脉压升高至39～62 mm Hg,考虑末梢血管痉挛所致。基本治愈8例,显效5例,有效3例,无效3例。19例随访2～26个月,平均18个月,未见复发。结论急性肺动脉栓塞的介入治疗可以迅速恢复肺灌流量且相对于外科手术微创、简单,与全身静脉溶栓比较更迅速、有效。

Interventional Therapy for Acute Pulmonary Embolism

Objective To explore the outcomes of interventional treatment for acute pulmonary embolism.Methods From October 2009 to May 2011,19 patients underwent inferior vena cava filter placement,pulmonary artery angiography plus transcatheter thrombus fragmentation and thrombolytic therapy,balloon catheter was employed in 12 of them.Low-molecular-weight heparin and Warfarin were given after the surgery to maintain PT-INR between 2 and 3.Results Intraoperative pulmonary artery angiography showed completely patent pulmonary arteries in 8 cases,and partially patent in the other 11.During the procedure,pulmonary arterial pressure decreased to 16-37 mm Hg in 16 patients and increased to 39-62 mmHg in the other 3,which we believed was caused by vasospasm of the distal vessels.Postoperative anticoagulation was given for 1 week,afterwards,8 patients were cured,5 were markedly improved,3 were improved,and 3 were not improved.All the patients were followed up for 2 to 26 months(mean,18 months),no recurrent embolism was observed during the period.Conclusions With interventional therapy,pulmonary circulation is recovered quickly after acute pulmonary embolism.Compared to surgical treatment,interventional therapy is less invasive,simpler,and more effective.