急性肺栓塞数字减影血管造影诊断和介入治疗的临床研究

目的 评价急性肺栓塞数字减影血管造影（DSA）诊断和介入治疗的意义。方法 13例临床高度怀疑肺栓塞患者经急诊肺动脉造影确诊后,立即采取选择性肺动脉插管溶栓、吸栓、碎栓、解痉、球囊扩张治疗。疗效评价指标为肺动脉楔压、肺动脉开通率、远端肺血管网显示率、血气分析、血氧饱和度、临床症状、体征改善情况．其中10例明确为下肢深静脉血栓脱落所致者，放置下腔静脉滤器后再行下肢深静脉溶栓治疗。结果 13例肺动脉造影全部为肺动脉主干或2个以上分支栓塞，介入治疗后肺动脉开通率80％～90％3例，91％～95％8例，完全开通3例；远端肺血管网显示率全部在90％以上，肺动脉楔压下降至25mmHg以下10例，25-30mmHg3例，血氧饱和度即刘改善，恢复至90％～95％9例，96％～100％4例．PaO2 90-95mmHg3例，〉95mmHg者10例，咳嗽、咯血、呼吸困难、胸痛完全消失11例，明显战轻2例。结论 肺动脉造影是肺栓塞诊断的金标准，介入治疗对急性大面积肺栓塞具有显著疗效，明显降低病死率。

STUDY OF DIGITAL SUBTRACTION ANGIOGRAPHY DIAGNOSIS AND INTERVENTION TREATMENT ON ACUTE PULMONARY EMBOLISM DISEASE

Objective To evaluate the significance of diagnosis and interventional treatment of digital subtraction angiography in acute pulmonary embolism disease. Methods 13 cases who were highly suspected and confirmed as pulmonary embolism by pulmonary artery angiography, took pulmonary arterial thrombolysis therapy, suction and fragmentation of thrombi, anti- spasm, and balloon kilation. Wedged pulmonary arterial pressure, pulmonary recanalization rate , the saturation, improvement of clinical symptoms and signs were used as evaluation indexes. 10 of the cases confirmed as dislodgement of deep vein thrombi of lower extremities, deep vein thrombolysis treatment of the lower extremities was also performed after placement of inferior vena cava filter. Results Pulmonary artery angiographies showed that embolism of the pulmonary arterial located in artery trunks or more than 2 branches. Post- treatment pulmonary patencies were 80% -90% in 3 cases,90% - 95% in 8 cases and 100% in 3 cases. The display ratio of distal pulmonary capillary net was over 90% in all the cases. Wedged pulmonary arterial pressure decreased to below 25mmHg in 10 cases, and to 25 - 30mmHg in 3 cases. Blood oxygen saturation rate improved immediately to 90% - 95% in 9 cases and to 95% - 100% in 4 cases. Cough, hemoptysis, dyspnea and chest pain were completely relieved in 13 cases and obviously relieved in 2 cases. Conclusion Pulmonary artery angiography is the golden standard for the diagnosis of pulmonary embolism. Interventional therapy is effective for acute pulmonary embolism, which can significantly reduce the mortality rate.