AngioJet机械性血栓抽吸术治疗急性肺栓塞的疗效与安全性：附3例报告并文献回顾

背景与目的 目前对于高危急性肺栓塞（PE）患者的治疗策略均存在增加包括颅内出血等严重出血事件的风险。AngioJet机械性血栓抽吸术（ART）在高压脉冲注射溶栓药溶解、粉碎血栓的同时，允许在段级肺动脉分支上进行抽吸，对于急性PE理论上是一种有效的措施，但其安全性需进一步评估。本研究回顾3例采用ART治疗急性PE的患者的病例资料，分析ART治疗急性PE的安全性与有效性。方法 回顾2021年6月─2021年9月于首都医科大学附属北京安贞医院血管外科3例行ART治疗的急性PE患者病例资料，比较患者生命体征变化及PE相关数据，分析ART治疗的安全与有效性。结果 ART手术成功率100%，所有患者ART后收缩期肺动脉压、三尖瓣环收缩期位移、右室内径/左室内径、血氧饱和度、B型利钠肽水平均较术前得到明显改善。3例患者均出现一过性心动过缓，对症治疗后均缓解。所有患者围术期未出现严重手术相关并发症。1例患者因“冠心病、感染中毒性休克、缺血缺氧性脑病”于术后36 d死亡，2例随访3个月，期间患者肺动脉压力、右心功能均得到明显恢复。结论 ART对于急性高危和中高危PE患者是安全有效的，为了减少ART相关并发症，应在术中动作轻柔，严格把控抽吸时间，操作过程中密切关注患者血压心率变化，必要时吸栓后追加使用低剂量溶栓药物，同时围术期充分水化，减少造影剂应用，以减少肾脏负担，避免急性肾功能不全发生。

Efficacy and safety of AngioJet rheolytic thrombectomy for acute pulmonary embolism: a report of 3 cases and literature review

Background and Aims All the current treatment strategies for high-risk acute pulmonary embolism (PE) patients will increase the risk of serious bleeding events that include the intracranial bleeding. AngioJet rheolytic thrombectomy (ART) enables a high-pressure pulse injection of thrombolytic agents to break down and dissolve the blood clots, and meanwhile allows aspiration in the pulmonary artery branches at the segmental level, which is theoretically an effective approach for acute PE. However, its safety needs to be further assessed. This study was conducted to analyzed the safety and efficacy of ART for the treatment of acute PE by reviewing the data of 3 patients with acute PE treated with ART.Methods The clinical data of three patients with acute PE treated by ART in the Center of Vascular Surgery of Beijing Anzhen Hospital, Capital Medical University from June 2021 to September 2021 were reviewed. The safety and effectiveness of ART treatment were evaluated by comparing the changes in vital signs and PE-related data of the patients.Results The technical success rate of ART was 100%. After ART, systolic pulmonary artery pressure, systolic displacement of the tricuspid ring, right ventricular diameter/left ventricular diameter ratio, blood oxygen saturation and B-type natriuretic peptide level were significantly improved in all patients. Transient bradycardia occurred in all the 3 patients, which was relieved after symptomatic treatment. No serious complications associated with surgery occurred in all patients during perioperative period. One patient died due to coronary heart disease, infectious-toxic shock, and ischemic hypoxic encephalopathy at 36 d after operation. The other two patients were followed-up for 3 months, and the pulmonary arterial pressure and right heart function of them were significantly recovered.Conclusion ART is a safe and effective method for patients with intermediate high-risk and high-risk acute PE. For reducing the ART-related complications, manipulation should be gentle, aspiration time should be strictly controlled, and close attention should be paid to the changes in blood pressure and heart rate of patients during the operation, and supplementation of low dose thrombolytic agent should be considered after ART if necessary. Meanwhile, adequate perioperative hydration and reduced use of the contrast agent can decrease the renal burden, so as to avoid the occurrence of acute renal insufficiency.