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目的:观察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动脉栓塞复发率和慢性血栓栓塞性肺高血压(CTEPH)等并发症的发生情况。方法:回顾性分析广西柳州市工人医院2013年1月至2015年1月收治的150例的中高危急性肺栓塞接受尿激酶介入溶栓治疗患者的临床资料,出院后进行门诊及电话随访。平均随访时间为(10.5±2.5)个月。随访研究终点为肺动脉栓塞复发和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(P<0.05);心率平均减慢(P<0.05);超声心动图显示肺动脉压力明显降低11mmHg(P<0.05);血气分析中氧分压平均升高15mmHg(P<0.05)、氧饱和度平均升高8%(P<0.05)、肺泡-动脉氧分压差平均降低22mmHg(P<0.05);D-二聚体升高23ug/L(P<0.05);N末端B型利钠肽原下降325.3pg/ml(P<0.05)。溶栓过程无严重出血不良事件。肺动脉栓塞复发率7.3%(11/150),肺栓塞相关病死率为4.0%(6/150),无一例新发CTEPH。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。
Objective: To observe the efficacy and safety of pulmonary artery thrombolysis in the treatment of acute pulmonary embolism. Follow-up observation of the incidence of pulmonary embolism recurrence and complications such as chronic thromboembolic pulmonary hypertension (CTEPH) were performed. Methods: The clinical data of 150 patients with middle-high risk acute pulmonary embolism receiving urokinase interventional thrombolysis from January 2013 to January 2015 in Liuzhou Workers’ Hospital of Guangxi were retrospectively analyzed. Outpatients were followed up and followed up by telephone. The average follow-up time was (10.5 ± 2.5) months. Follow-up study endpoints of pulmonary embolism and pulmonary embolism pulmonary hypertension and mortality. Results: Compared with that before thrombolysis, the respiratory rate of patients after thrombolytic therapy decreased by an average of 10 beats / min (P <0.05), and the heart rate slowed down on average (P <0.05). Echocardiography showed that pulmonary artery pressure was significantly reduced by 11mmHg P <0.05). The oxygen partial pressure increased by 15mmHg (P <0.05), the oxygen saturation increased by 8% (P <0.05) and the average alveolar-arterial oxygen pressure decreased by 22mmHg (P < ; D-dimer increased 23ug / L (P <0.05); N-terminal B-type natriuretic peptide decreased 325.3pg / ml (P <0.05). Thrombolytic process without serious bleeding adverse events. Pulmonary embolism recurrence rate of 7.3% (11/150), pulmonary embolism-related mortality was 4.0% (6/150), no new cases of CTEPH. Conclusion: Pulmonary arterial thrombolysis can effectively improve lung function, right heart function and prognosis in patients with acute pulmonary thromboembolism. It is a safe and minimally invasive treatment.