基于CTI%的急性肺动脉血栓栓塞的导管碎栓/抽栓联合局部溶栓治疗
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1.南京医科大学;2.南京医科大学附属常州第二人民医院

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常州市高层次卫生人才培养工程(2016CZBJ009)


Catheter crushing/aspiration thrombus combined with local thrombolytic therapy for acute pulmonary thromboembolism based on CTI%
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    摘要:

    目的:探讨基于CT肺动脉栓塞指数(CTI%)的急性肺动脉血栓栓塞(APTE)的导管碎栓/抽栓联合局部溶栓治疗的安全性与有效性。方法:回顾性分析2011年1月至2022年3月期间经导管碎栓/抽栓联合局部溶栓治疗的APTE患者的临床及影像资料,并基于CTI%对患者进行分度。结果:共纳入50例患者,基于CTI%的分度:轻、中、重度APTE 患者分别为11例(22.0%)、17例(34.0%)、22例(44.0%)。基于CTI%的分度与简化肺栓塞严重指数(sPESI)无明显相关(P=0.225)。三组患者术前的血氧饱和度和D-二聚体表达水平的差异均具有统计学意义(P<0.05)。50例患者中,导管碎栓联合局部溶栓治疗12例(24.0%),导管抽栓联合局部溶栓治疗37例(74.0%),导管碎栓、抽栓联合局部溶栓治疗1例(2.0%),手术成功率为100%,临床成功率为88.0%(44/50)。围术期死亡6例(12.0%,中度1例,重度5例),其余44例患者顺利出院。规律随访患者36例(81.8%),平均随访时间34.6±33.1月,无APTE复发、抗凝相关的并发症发生。有5例(13.9%,中度2例、重度3例)发生肺动脉高压,10例(27.8%,轻度3例、中度4例、重度3例)发生左室舒张功能减退。结论:导管碎栓/抽栓联合局部溶栓治疗APTE安全有效;基于CTI%的中-重度APTE患者围术期死亡率及术后肺动脉高压和心功能不全的发生率较高。

    Abstract:

    Objective: To investigate the safety and efficacy of catheter crushing/aspiration thrombus combined with local thrombolytic therapy for acute pulmonary thromboembolism (APTE) based on pulmonary artery computed tomography obstruction index (CTI%). Methods: The clinical and imaging data of APTE patients who received catheter crushing/aspiration thrombus combined with local thrombolytic therapy from January 2011 to March 2022 were analyzed and graded by CTI%. Results: Fifty patients, including mild (n=11, 20.0%), moderate (n=17, 34.0%) and severe (n=22, 44.0%) APTE by CTI%, were included. The grading based on CTI% had no obvious correlation with simplified pulmonary embolism severity index (sPESI) (P=0.225). There were significant differences in preoperative blood oxygen saturation and D-dimer levels among the three groups (P< 0.05). Among the 50 patients, 12 cases (24.0%) were treated by catheter crushing thrombus combined with local thrombolysis, 37 cases (74.0%) by catheter aspiration thrombus combined with local thrombolysis, and 1 case (2.0%) by catheter crushing thrombus/aspiration thrombus combined with local thrombolysis. The technic success rate was 100% and clinical success rate was 88.0% (44/50). The perioperative mortality was 12.0% (6/50, 1 case in moderate APTE, 5 cases in severe APTE). Of the 44 patients, 36 cases were followed up regularly. With mean 34.6±33.1 months follow-up and there were no APTE recurrence and anticoagulation related complications. Pulmonary hypertension occurred in 5 patients (13.9%, 2 cases in moderate APTE, 3 cases in severe APTE) and ten patients (27.8%, 3 cases in mild APTE, 4 cases in moderate APTE, 3 cases in severe APTE) had left ventricular diastolic dysfunction. Conclusions: Catheter crushing/aspiration thrombus combined with local thrombolytic therapy is safe and effective in the treatment of APTE. Patients with moderate to severe APTE by CTI% have high perioperative mortality and high risk of pulmonary hypertension and cardiac insufficiency.

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  • 收稿日期:2022-08-22
  • 最后修改日期:2022-11-14
  • 录用日期:2023-05-23
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