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华西医学  2010 

导管介入治疗急性肺栓塞的临床疗效观察

, PP. 1403-1405

Keywords: 肺栓塞,介入治疗,肺动脉,溶栓术

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Abstract:

【】目的观察经皮导管介入治疗急性肺栓塞的疗效。方法选择2003年1月-2009年6月收治的急性肺栓塞患者15例,采用经皮导管吸栓术、碎栓术及溶栓术治疗。溶栓术用局部灌注加即刻静脉注射尿激酶,总量100万U。溶栓后给予低分子肝素7~10d,口服华法林3~6个月。观察临床症状、体征改善情况、并发症、平均肺动脉压(mPAP)与动脉血氧分压(PO2)的变化,以及肺动脉开通情况。结果12例肺动脉完全开通,3例部分开通,显效率89%,有效率100%。mPAP从(41.07±6.97)mmHg降到(21.00±5.66)mmHg,PO2从(46.26±9.30)mmHg升到(79.49±8.04)mmHg,治疗前后差异有统计学意义(P<0.05)。即刻临床症状明显改善,mPAP迅速降低11例。随访3~6个月,疗效持续,未见复发。结论介入治疗急性肺栓塞疗效显著,安全可行,对抢救危重患者、改善临床症状、维持血流动力学稳定有重要作用。?【Abstract】ObjectiveToobservetheclinicalcurativeeffectonacutepulmonaryembolism(PE)viapercutaneouscatheterintervention.MethodsFifteenacutePEpatientsadmittedfromJanuary2003toJune2009weretreatedwithpercutaneouscatheterdrawingofthrombus,thrombectomy,andthrombolysis.Localinfusionandimmediateintra-?venousinjectionofurokinasewith100000000Uintotalwereusedforthrombolysis.Afterwards,thelowmolecularweightheparinwasgivenforseventotendays,andanoralintakeofwarfarinlastsforthreetosixmonths.Observetheclinicalsymptoms,improvementofphysicalsigns,occurrenceofcomplications,changeofmeanpulmonaryarterialpressure(mPAP)andarterialpartialpressureofoxygen(PO2),aswellasthepatencyconditionofpulmonaryartery.ResultsTwelveoffifteerpatientsgainedcompletepatencyofpulmonaryartery,andtheotherthreepatientsgainedpartialpatency,withanobviouseffectivenessrateof89%andaneffectivenessrateof100%.mPAPdecreasedfrom(41.07±6.97)mmHgto(21.00±5.66)mmHg,andPO2elevatedfrom(46.26±9.30)mmHgto(79.49±8.04)mmHg,showingasignificantdifference(P<0.05)beforeandafterthetherapy.Theimmediateclinicalsymptomsexhibitedasignificantimprovement.Thepulmonaryarterypressureof11patientsdroppedrapidly.Duringthreetosixmonths’followup,thetherapeuticeffectspersistedandnorecurrencewasfound.ConclusionTheinterventionaltreatmentofacutePEdemonstratesremarkableeffectiveness,safetyandfeasibility,whichplaysanimportantroleintherescueofcriticalpatients,improvementofclinicalsymptoms,andmaintenanceofhemodynamicstability.

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