Amplatz血栓消融器治疗大块肺栓塞的临床应用

目的 探讨Amplatz血栓消融器(ATD)治疗大块肺栓塞(PE)的可行性。方法2001年2月-12月对3例大块中心型PE患者实施Amplatz血栓消融术。3例患者分别为溶栓治疗无效、贻误有效溶栓时机以及溶栓过程中出现大咯血者。结果3例患者血栓消融术全部成功。术后随访4—10个月，肺灌注均明显改善，尤中期效果显著。第1例患者原近乎完全闭塞的右肺动脉主干仅远端和右肺上叶动脉遗留少许附壁血栓，左肺动脉主干远端血栓消失。术后7个月核素肺灌注显像大致正常。第2例患者于肺动脉血栓消融术中气短减轻，心率由80次／min降至67次／min。术后PaO2由66．4mmHg(1mmHg=0．133kPa)升至84．2mmHg。肺动脉收缩压由53．5mmHg降至正常。术后6个月，电子束扫描体层摄影显示，原左、右肺动脉主干远端及各叶动脉内的充盈缺损基本消失，各段肺动脉充盈较前明显改善。9个月时，核素肺灌注大致正常。第3例患者术后PaO2由74．3mmHg升至90．3mmHg；核素肺灌注显像及电子束扫描体层摄影均显示明显改善；超声示左右肺动脉内血栓消失，肺动脉收缩压由60．0mmHg降至正常。术后3个月余除右肺外段灌注呈亚肺段缺损区外，双肺放射性分布大致均匀。仅1例患者术中出现左侧轻微胸痛。术后均无溶血的临床表现。结论对急性、亚急性大块、中心型肺栓塞患者实施。Amplatz血栓消融术技术上是可行的，且安全、有效，特别是对存在溶栓禁忌或溶栓失败的患者，具有重要的临床价值。但确切疗效及评价有待大规模临床试验证实。

Clinical application of the Amplatz thrombectomy device in massive pulmonary embolism

Objective To evaluate the feasibility of using the Amplatz thrombectomy device in central massive pulmonary embolism(PE) Methods Mechanical thrombectomy with ATD(7F) was performed successfully in 3 male patients with documented thrombus in the left and right pulmonary arteries resulting from deep vein thrombosis Results During the period of follow up for 4 to 10 months marked improvement in pulmonary perfusion was observed in all patients investigated by ultrafast computed tomography and perfusion pulmonary scan The systolic pulmonary arterial pressure decreased from 34.0 mm Hg, 53 5 mm Hg and 60 0 mm Hg to normal values,respectively PaO 2 increased from 53 8 mm Hg to 80 0 mm Hg, 66 4 mm Hg to 83 6mm Hg and 74 3mm Hg to 90 3mm Hg, respectively Only one patient developed mild left chest pain Conclusion Mechanical thrombectomy with the ATD in patients with subacute massive PE seems technically feasible,safe and effective It is a potential alternative to drug mediated thrombolysis and surgery However, the incremental benefit of the ATD over conventional treatments could be shown only in a randomized controlled study