介入联合静脉溶栓在急性肺栓塞治疗中的应用

目的：探讨介入治疗联合低剂量长时间经静脉溶栓在急性肺栓塞治疗中的效果和安全性。方法对62例急性肺栓塞患者，行肺动脉造影明确栓子部位，应用导管导丝碎栓及团注尿激酶接触性溶栓行介入肺动脉溶栓术。明确有下肢深静脉血栓形成者，介入溶栓术后放置可取出下腔静脉滤器，之后予经上肢浅静脉持续应用尿激酶溶栓治疗3~7 d。观察患者临床症状、肺动脉血栓清除情况、血氧饱和度（SpO2）、动脉血氧分压（PaO2）等指标，术后10 d内行肺动脉CT血管造影（CTA）复查，根据综合情况考虑是否在滤器置入后10~12 d取出滤器。结果本组患者均成功行介入溶栓术及联合静脉溶栓，62例患者治疗后临床症状均明显改善，SpO2及PaO2明显升高；CTA复查肺动脉内血栓完全清除或大部分清除。53例明确有下肢深静脉血栓形成者，介入溶栓术后放置可取出下腔静脉滤器，43例于术后10~12 d取出下腔静脉滤器，无严重手术及溶栓相关并发症。结论介入治疗联合低剂量长时间经静脉溶栓治疗急性肺栓塞是一种安全易行、创伤小、疗效确切的方法。

Application of Interventional Treatment Combined with Intravenous Thrombolysis in the Treatment of Acute Pulmonary Embolism

Objective To evaluate the efficacy and safety of interventional treatment combined with low-dose and long-time intravenous thrombolysis in the treatment of acute pulmonary embolism （PE）.Methods Pulmonary angiography of 62 patients with acute PE was conducted to verify the location of thrombus. Interventional thrombolytic therapy of the patients was conducted by using mechanical thrombectomy with catheter and wire as well as catheter directed thrombolysis （CDT） with bolus injection of urokinase. The retrievable inferior vena cava iflters were implanted in the patients who were diagnosed as lower extremity deep venous thrombosis （LEDVT）. Then continuous intravenous thrombolysis with urokinase was performed on these patients for 3~7 d via their upper extremity superifcial veins. The clinical status, clearance situation of thrombus, blood oxygen saturation （SpO2） and arterial oxygen partial pressure （PaO2） were observed and recorded. CT angiography of pulmonary artery of the patients was performed within 10 d after the treatment to evaluate the clearance situation of thrombus. Then the filter would be considered to be retrieved at 10~12 d after the post-implantation according to the comprehensive situation of the patients.Results Interventional treatment combined with intravenous thrombolysis of all the patients was conducted successfully. The clinical status of all the patients was improved obviously such as the obvious elevation of SpO2 and PaO2 as well as the good clearance situation of thrombus. The retrievable inferior vena cava iflters were implanted in 53 patients who were diagnosed as LEDVT. The iflters of 43 patients were retrieved at 10~12 d after the post-implantation without serious complications.Conclusion Interventional treatment combined with low-dose and long-time intravenous thrombolysis is a safty, less trauma durable and effective therapy strategy for acute PE.