导管引导介入治疗急性中高危肺动脉栓塞临床研究

目的:评估导管引导介入治疗急性中高危肺动脉栓塞的有效性及安全性。方法:顾性分析2012年1月至2018年6月在柳州市工人医院血管外科诊治的112例急性中高危肺动脉栓塞患者资料。根据治疗方案分单纯抗凝组(共38例)、导管介入+抗凝治疗组(共74例),对比两组肺动脉压及肺动脉栓塞严重指数降低情况、肺栓塞症状改善率、住院时长和出血并发症发生率;以其随访中肺栓塞复发率和慢性血栓性肺动脉高压发生率。根据介入方案不同,介入治疗组包括AngioJet机械吸栓(共13例)、猪尾导管碎栓及溶栓(61例);分别对比两种介入方案术前及术后的动脉血氧分压、指脉氧、心率及肺动脉压、弥勒指数评估治疗效果。结果:两组术前人口学特征、发病时间、DVT并发率、肺动脉压、肺动脉栓塞严重指数等无明显差异(P均0.05)。介入治疗组在降低肺动脉压及肺动脉严重指数、症状的改善率、缩短住院时间上明显优于单纯抗凝组(P分别为0.000、0.001、0.01、0.003);而相关出血并发症发生率无统计学差异(P0.05)。通过分别对比介入治疗两种方案的术前及术后动脉血氧分压、指脉氧、心率及肺动脉压、弥勒指数,两种治疗方案在这五个指标均有明显改善(P值均0.05)。随访6月至7年,肺栓复发率在单纯抗凝组、导管介入+抗凝治疗组分别为10.5%、6.8%,统计学差异显著(P=0.004);慢性血栓性肺动脉高压发生率分别为5.3%、1.4%,统计学差异显著(P=0.000)。结论:导管引导介入治疗对急性中高危肺动脉栓塞治疗是安全有效的,且可明显降低复发及慢性肺动脉高压的发生率。

Clinical Study of Catheter-directed Interventional Therapy for Acute Intermediate- and High-risk Pulmonary Embolism

ABSTRACT Objective: To evaluate the efficacy and safety of catheter-directed interventional therapy for acute intermediate- and high-risk pulmonary embolism. Methods: A retrospective analysis of 112 cases with acute intermediate- and high-risk pulmonary embolism diagnosed and treated in vascular surgery of Liuzhou Workers'' Hospital from January 2012 to June 2018. According to the therapy, all cases were divided into two groups, the anticoagulation group (38 cases) and the catheter-directed intervention combining with anticoagulation group (74 cases), Five indictors were compared between two groups, which included decrease of the pulmonary arterial pressure and pulmonary embolism severity index, symptomatic improvement rate, length of hospital stay and bleeding complication. According to intervention methods, the catheter-directed intervention group were divided into two groups, including AngioJet mechanical thrombectomy group (13 cases) and pigtail catheter fragmentation and thrombolysis (61 cases). Therapeutic effects of these two interventions were evaluated respectively by comparing the preoperative and postoperative arterial oxygen partial pressure, finger oxygen saturation, heart rate, pulmonary artery pressure, and Miller Index. Results: There were no significant differences in preoperative demographic characteristics, onset time, DVT concomitant rate, pulmonary artery pressure, and pulmonary embolism severity index (P>0.05). The CDI group was significantly better than the anticoagulation group in reducing pulmonary arterial pressure and pulmonary artery severity index, symptom improvement, and shortening hospitalization time. There was no significant difference in the incidence of bleeding complications(P>0.05). Comparing the preoperative and postoperative arterial oxygen partial pressure, finger oxygen saturation, heart rate, pulmonary artery pressure, and Miller Index of the two CDI groups, all the five indicators were significantly improved in both the two therapies(P<0.05). During the follow-up period from 6 months to 7 years, the recurrence rate of PE was 10.5 % and 6.8 % in the anticoagulation group and the catheter intervention + anticoagulation group, respectively. The statistical difference was significant (P=0.004). And the incidence of chronic thrombotic pulmonary hypertension was respectively 5.3 % and 1.4 %, the statistical difference was significant (P=0.000). Conclusion: Catheter-directed interventional therapy is safe and effective for the treatment of acute intermediated- and high-risk pulmonary embolism. CDI can significantly reduce the incidence of recurrence and chronic pulmonary hypertension.