肺动脉介入溶栓治疗急性肺栓塞疗效分析.docVIP

肺动脉介入溶栓治疗急性肺栓塞疗效分析 　　【摘 要】目的 分析肺动脉介入溶栓治疗急性肺动脉栓塞患者的疗效和安全性，并随访观察治疗后肺栓塞复发和慢性血栓栓塞性肺高血压（CTEPH）等并发症的发生情况。方法 回顾性分析大连大学附属中山医院和广西柳州市工人医院2012年7月至2014年7月收治的200例的中高危急性肺动脉栓塞接受尿激酶介入溶栓治疗患者的临床资料，之后进行门诊及电话随访。平均随访时间为（12.5±3.5）个月。随访研究终点为肺栓塞复发、肺栓塞性肺动脉高压及死亡率。结果 与溶栓前比较，尿激酶溶栓后患者的呼吸频率平均减慢10次/分（P0.01）；心率[（85.0±10.0）次/min比（110.0±12.0）次/min，P0.01]；超声心动图显示肺动脉压力明显降低[（37.2±4.5）mmHg比（48.6±8.2）mm Hg，P0.01]；血气分析中氧分压平均升高15mmHg[（85.5±11.3）mm Hg比（71.2±10.6）mm Hg，P0.01]、氧饱和度平均升高6.8%[（95.6%±3.2%）比（87.5%±4.3%），P0.01]、肺泡-动脉氧分压差[平均18.5mmHg比40.2mmHg，P0.01]明显降低；D一二聚体明显升高（P0.001）；N末端B型利钠肽原明显下降（P0.001）。溶栓过程无严重出血不良事件。肺栓塞复发率4.0%（8/200），肺栓塞相关病死率为3.5%（7/200）。结论 肺动脉介入溶栓治疗可有效改善急性肺血栓栓塞症患者肺功能、右心功能及预后，是一种疗效显著、安全、微创的治疗方法。 　　【关键词】 肺动脉栓塞；介入溶栓；尿激酶；慢性肺动脉高压 　　Efficacy of intervention thrombolytic therapy on acute pulmonary embolism 　　Hao Guo-qiang，Wei Li-chun，Xing Zhuang-jie，Hou Pei-yong * 　　Vascular Surgery，Zhongshan Hospital Affiliated Dalian University，Dalian，116001 　　Vascular Surgery，Liuzhou Workers，Hospital，Liuzhou，545005 　　【Abstract】 Objective To analyze the efficacy and safety on the pulmonary artery interventional thrombolysis in patients with acute pulmonary embolism，and the incidence of post-treatment follow-up observation of recurrent pulmonary embolism and chronic thromboembolic pulmonary hypertension（CTEPH）and other complications. Methods A retrospective analysis is made respecting 200 patients with high-risk acute pulmonary embolism，who were treated by intervention thrombolytic therapy in Zhongshan Hospital Affiliated Dalian University and Liuzhou Workers，Hospital from July 2012 to July 2014. This study is made by outpatient and telephone follow-up. Mean follow-up time was（12.5±3.5）months. Follow-up study endpoint are recurrent pulmonary embolism，pulmonary hypertension and mortality. Results Compared with before and after thrombolytic treating patients，average respiratory rate slows 10 beats/min（P 　　【Key words】pulmonary embolism；interventional thrombolysis；urokinase；chronic pulmonary hypertension 　　肺动