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目的探讨急性肺动脉栓塞的治疗策略。方法回顾性分析川北医学院附属医院血管外科2009年1月至2014年5月期间收治的48例肺动脉栓塞患者的临床资料,分析其临床疗效及并发症发生情况。结果 48例患者中,14例低危患者行抗凝治疗,24例中危患者行抗凝和系统溶栓或介入治疗(导管捣碎局部溶栓或置管溶栓),10例高危患者行抗凝治疗和介入治疗。低危组14例患者中,治愈12例(85.7%),显效2例(14.3%),总有效率为100%;中危组24例患者中,治愈16例(66.7%),显效8例(33.3%),总有效率为100%;高危组10例患者中,治愈3例,显效2例,好转4例,死亡1例,总有效比例为9/10。治疗期间所有病例均无消化道出血、脑出血等并发症发生。本组48例患者均获访,随访时间为3~12个月,中位数为8个月。随访期间患者均无呼吸困难等症状发生,无一例再发肺动脉栓塞,无滤器移位、血栓形成等并发症发生。结论对诊断明确的急性肺动脉栓塞患者首先进行危险分层,再采取相应的治疗策略,则效果较好。
Objective To investigate the treatment strategy of acute pulmonary embolism. Methods The clinical data of 48 patients with pulmonary embolism admitted from January 2009 to May 2014 in Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College were retrospectively analyzed. The clinical efficacy and complications were analyzed. Results Of the 48 patients, 14 cases of low-risk patients underwent anticoagulant therapy. Twenty-four patients with moderate-risk patients underwent anticoagulation and systemic thrombolysis or interventional therapy (catheterized local thrombolysis or catheterization) and 10 high-risk patients Anticoagulant therapy and interventional therapy. Among the 14 patients in the low-risk group, 12 (85.7%) were cured, 2 (14.3%) were markedly effective and the total effective rate was 100%. Among the 24 patients in the low-risk group, 16 (66.7%) were cured and 8 (33.3%). The total effective rate was 100%. Among 10 patients in high risk group, 3 cases were cured, 2 cases markedly improved, 4 cases improved, and 1 case died. The total effective rate was 9/10. During the treatment of all cases no gastrointestinal bleeding, cerebral hemorrhage and other complications. The group of 48 patients were followed up for 3 to 12 months, the median was 8 months. During the follow-up period, none of the patients had symptoms such as dyspnea, and no other cases had recurrent pulmonary embolism, no filter displacement and thrombosis. Conclusion Risk stratification is first performed in patients with diagnosed acute pulmonary embolism, and then the corresponding treatment strategy is taken, the effect is better.