| 引用本文: | 魏立春,苏奕明,许太福,罗长志,张科,韦肖敏,叶奕辉,蓝宇俭,王有福,侯培勇.机械性吸栓与单纯置管溶栓在中/高危急性肺动脉栓塞治疗中的对比观察[J].中国临床新医学,0,():-. |
| 魏立春,Su Yiming,Xu Taifu,Luo Changzhi,Zhang Ke,Wei Xiaomin,Ye Yihui,Lan Yujian,Wang Youfu,Hou Peiyong.机械性吸栓与单纯置管溶栓在中/高危急性肺动脉栓塞治疗中的对比观察[J].中国临床新医学,0,():-. |
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| 机械性吸栓与单纯置管溶栓在中/高危急性肺动脉栓塞治疗中的对比观察 |
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魏立春1,2, 苏奕明1,2, 许太福1,2, 罗长志1,2, 张科1,2, 韦肖敏1,2, 叶奕辉1,2, 蓝宇俭1,2, 王有福1,2, 侯培勇1,2
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1.广西医科大学第四附属医院血管外科 广西柳州 2.545005
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| 摘要: |
| 目的 对比AngioJet机械性吸栓术与单纯导管碎栓联合溶栓术治疗中/高危急性肺动脉栓塞的临床效果和安全性。方法 回顾性分析36例中高危急性肺动脉栓塞（APE）患者的临床资料，AngioJet机械性吸栓治疗12例（吸栓组），单纯导管碎栓联合溶栓治疗24例（溶栓组），比较两组患者的技术成功率、治疗成功率、术中操作时间、尿激酶用量、血氧饱和度（SpO2）、心律失常发生率、肺血管损伤发生率、肾功能损害发生率、出血发生率。结果 吸栓组vs.溶栓组的技术成功率为91.7%（11/12）vs.95.8%（23/24），无统计学意义（P>0.05）；吸栓组vs.溶栓组的治疗成功率（顺利出院）为75.0%（9/12）vs.79.2%（19/24），无统计学意义（P>0.05）；吸栓组vs.溶栓组的术中操作时间（357）min vs.（185）min，有统计学意义（P<0.05）；吸栓组vs.溶栓组的尿激酶用量（62）万iu vs.（205）万iu，有统计学意义（P<0.05）；血氧饱和度（SpO2）每组组内术后与术前对比以及两组组间对比均有统计学意义（P<0.05）；肺血管损伤发生率、肾功能损害发生率及PE复发率均无统计学意义（P>0.05）；心律失常（突发心动过缓、室速、窦或室性心动过速等）发生率吸栓组vs.溶栓组为25.0%（3/12）vs.12.5%（3/24），有统计学意义（P<0.05）；出血发生率吸栓组vs.溶栓组为0.0%vs.33.3%（8/24），有统计学意义（P<0.05）。 结论 AngioJet机械性吸栓与单纯导管碎栓联合溶栓术均是治疗中/高危急性肺动脉栓塞的有效微创疗法；对于存在出血倾向者，机械性吸栓在安全性上更具优势；轻柔、短暂、细致操作能够提高机械吸栓或置管溶栓治疗的安全性。 |
| 关键词: 肺栓塞 机械性吸栓 置管溶栓 |
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| 基金项目:柳州市科技计划项目(2019BJ0606) |
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| Comparison of mechanical thrombectomy and thrombolysis in the treatment of intermediate/high risk acute pulmonary embolism |
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魏立春,Su Yiming,Xu Taifu,Luo Changzhi,Zhang Ke,Wei Xiaomin,Ye Yihui,Lan Yujian,Wang Youfu,Hou Peiyong
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Wei Lichun
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| Abstract: |
| Objective To compare the clinical efficacy and safety of AngioJet mechanical thrombectomy and catheter thrombectomy combined with thrombolysis in the treatment of intermediate/high risk acute pulmonary embolism. Methods The clinical data of 36 patients with intermediate and high risk acute pulmonary embolism (APE) were retrospectively analyzed. AngioJet mechanical thrombectomy therapy was performed in 12 cases (thrombectomy group), catheter thrombectomy combined with thrombolysis therapy in 24 cases (thrombolysis group). The technical success rate, treatment success rate, intraoperative operation time, urokinase dosage, blood oxygen saturation (SpO2), incidence of arrhythmia, pulmonary vascular injury, renal impairment, and bleeding were compared between the two groups. Results The technical success rate of thrombolysis group vs. thrombolysis group was 91.7% (11/12) vs.95.8% (23/24), without statistical significance (P>0.05). The success rate of treatment (discharge) in thrombolysis group vs. thrombolysis group was 75.0% (9/12) vs.79.2% (19/24), with no statistical significance (P>0.05). The intraoperative operation time of thrombolysis group vs. thrombolysis group was (357) min vs. (185) min, with statistical significance (P<0.05). The dosage of urokinase in thrombectomy group vs. thrombolytic group was (62) million IU vs. (205) million IU, with statistical significance (P<0.05). There were significant differences in blood oxygen saturation (SpO2) between the two groups (P<0.05). There were no significant differences in the incidence of pulmonary vascular injury, renal dysfunction and PE recurrence (P>0.05). Incidence of arrhythmias (sudden bradycardia, ventricular tachycardia, sinus or ventricular tachycardia, etc.) The thrombolysis group was 25.0% (3/12) vs.12.5% (3/24), with statistical significance (P<0.05). The incidence of bleeding in mechanical thrombectomy group was 0.0%vs.33.3% (8/24) in thrombolysis group, with statistical significance(P<0.05). Conclusion AngioJet mechanical thrombectomy and thrombectomy alone is an effective minimally invasive therapy for intermediate/high risk acute pulmonary embolism. For those with bleeding tendency, mechanical thrombectomy has more advantages in safety. Gentle, brief and careful operation can improve the safety of mechanical thrombectomy or catheterization. |
| Key words: Pulmonary embolism Mechanical thrombus aspiration Catheterization thrombolysis |
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