导管介入治疗急性肺栓塞的临床疗效观察

目的观察经皮导管介入治疗急性肺栓塞的疗效。方法选择2003年1月-2009年6月收治的急性肺栓塞患者15例,采用经皮导管吸栓术、碎栓术及溶栓术治疗。溶栓术用局部灌注加即刻静脉注射尿激酶,总量100万U。溶栓后给予低分子肝素7～10d,口服华法林3～6个月。观察临床症状、体征改善情况、并发症、平均肺动脉压（mPAP）与动脉血氧分压（PO2）的变化,以及肺动脉开通情况。结果 12例肺动脉完全开通,3例部分开通,显效率89%,有效率100%。mPAP从（41.07±6.97）mmHg降到（21.00±5.66）mmHg,PO2从（46.26±9.30）mmHg升到（79.49±8.04）mmHg,治疗前后差异有统计学意义（P〈0.05）。即刻临床症状明显改善,mPAP迅速降低11例。随访3～6个月,疗效持续,未见复发。结论介入治疗急性肺栓塞疗效显著,安全可行,对抢救危重患者、改善临床症状、维持血流动力学稳定有重要作用。

Clinical Curative Effect on Acute Pulmonary Embolism via Percutaneous Catheter Intervention

Objective To observe the clinical curative effect on acute pulmonary embolism（ PE） via percutaneous catheter intervention. Methods Fifteen acute PE patients admitted from January 2003 to June 2009 were treated with percutaneous catheter drawing of thrombus,thrombectomy,and thrombolysis. Local infusion and immediate intra-venous injection of urokinase with 100 000 000 U in total were used for thrombolysis. Afterwards,the low molecular weight heparin was given for seven to ten days,and an oral intake of warfarin lasts for three to six months. Observe the clinical symptoms,improvement of physical signs,occurrence of complications,change of mean pulmonary arterial pressure （ mPAP） and arterial partial pressure of oxygen （ PO2） ,as well as the patency condition of pulmonary artery. Results Twelve of fifteer patients gained complete patency of pulmonary artery,and the other three patients gained partial patency,with an obvious effectiveness rate of 89% and an effectiveness rate of 100%. mPAP decreased from （ 41. 07 ± 6. 97） mm Hg to （ 21. 00 ± 5. 66） mm Hg,and PO2 elevated from （ 46. 26 ± 9. 30） mm Hg to （ 79. 49 ± 8. 04） mm Hg,showing a significant difference （ P〈 0. 05） before and after the therapy. The immediate clinical symptoms exhibited a significant improvement. The pulmonary artery pressure of 11 patients dropped rapidly. During three to six months＇ follow up,the therapeutic effects persisted and no recurrence was found. Conclusion The interventional treatment of acute PE demonstrates remarkable effectiveness,safety and feasibility,which plays an important role in the rescue of critical patients,improvement of clinical symptoms,and maintenance of hemodynamic stability.