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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,行门诊及电话随访。随访时间(12.5±3.5)个月。研究终点为肺栓塞复发、肺栓塞性肺动脉高压及死亡。结果溶栓后呼吸频率较治疗前减慢[(20.0±4.0)次/min vs(30.0±5.0)次/min,P<0.01];心率也较治疗前减慢[(85.0±10.0)次/min vs(110.0±12.0)次/min,P<0.01]。治疗后动脉血氧分压(PO_2)较治疗前升高[(85.5±11.3)mm Hg vs(71.2±10.6)mm Hg,P<0.01]、血氧饱和度(SO_2)较治疗前升高[(95.6±3.2)%vs(87.5±4.3)%,P<0.01]、肺泡-动脉血氧分压差[P(A-a)O_2]较治疗前明显降低[18.5 mm Hg vs 40.2 mm Hg,P<0.01]。D-二聚体较治疗前明显升高[(30.0±3.2)mg/L vs(7.5±1.3)mg/L,P<0.01];N末端B型利钠肽原较治疗前明显下降[(2 135±327)ng/L vs(21 960±1 356)ng/L,P<0.01]。溶栓过程无严重出血不良事件发生。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。
Objective To analyze the efficacy and safety of pulmonary artery interventional thrombolysis in patients with acute pulmonary embolism and to observe the incidence of complications such as recurrent pulmonary embolism and chronic thromboembolic pulmonary hypertension (CTEPH) after treatment. Methods The clinical data of 200 patients with moderate-to-high-risk acute pulmonary embolism admitted to Zhongshan Hospital Affiliated to Dalian University and Liuzhou Workers Hospital of Guangxi University from July 2012 to July 2014 were retrospectively analyzed. Outpatients and telephone follow-up . Follow-up time (12.5 ± 3.5) months. The study endpoints included pulmonary embolism, pulmonary embolism, and death. Results After thrombolysis, the respiratory rate was slower than before treatment [(20.0 ± 4.0) times / min vs (30.0 ± 5.0) times / min, P <0.01) min vs (110.0 ± 12.0) times / min, P <0.01]. The arterial partial pressure of oxygen (PO_2) increased (85.5 ± 11.3 mm Hg vs (71.2 ± 10.6) mm Hg, P <0.01] and the oxygen saturation (SO_2) P <0.01). The difference of P (Aa) O_2 was significantly lower than that before treatment [18.5 mm Hg vs 40.2 mm Hg (95.6 ± 3.2)% vs (87.5 ± 4.3)%, P < 0.01]. D-dimer was significantly higher than that before treatment [(30.0 ± 3.2) mg / L vs (7.5 ± 1.3) mg / L, P <0.01] 2 135 ± 327 ng / L vs 21 960 ± 1 356 ng / L, P <0.01]. Thrombolytic process without serious bleeding adverse events. The relapse rate was 4.0% (8/200) for pulmonary embolism and 3.5% (7/200) for pulmonary embolism. 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.