Division of Pulmonary and Critical Care Medicine, Albert Einstein Medical Center/Thomas Jefferson University School of Medicine, Philadelphia, PA, USA.
Crit Care Med. 2011 Nov;39(11):2413-8. doi: 10.1097/CCM.0b013e31822571b2.
Saddle pulmonary embolism represents a large clot and a risk for sudden hemodynamic collapse. However, the clinical presentation and outcomes vary widely. On the basis of the findings of right heart dysfunction on echocardiograms, computed tomography angiography, or cardiac enzyme elevation, some argue for the use of thrombolytics or catheter thrombectomy even for hemodynamically stable patients.
To investigate the outcomes and management of patients with saddle pulmonary embolism, including radiographic appearance (estimate of clot burden) and echocardiographic features.
None.
This study is a retrospective evaluation of all patients with computed tomography angiography positive for pulmonary embolism from June 1, 2004, to February 28, 2009. Two radiologists selected those with saddle pulmonary embolism and evaluated the clot burden score. The clinical information, echocardiography, treatments, and outcomes of these patients were extracted via chart review. Saddle pulmonary embolism was found in 37 of 680 patients (5.4%, 95% confidence interval 4% to 7%) with documented pulmonary embolism on computed tomography angiography. For patients with saddle pulmonary embolism, the median age was 60 yrs and 41% were males. Major comorbidities were neurologic (24%), recent surgery (24%), and malignancy (22%). Transient hypotension occurred in 14% and persistent shock in 8%. One patient required mechanical ventilation. Echocardiography was performed in 27 patients (73%). Right ventricle enlargement and dysfunction were found in 78% and elevated pulmonary artery systolic pressure in 67%. Computed tomography angiography demonstrated a high median pulmonary artery clot burden score of 31 points. The median right ventricle to left ventricle diameter ratio was 1.39. Inferior vena cava filters were placed in 46%. Unfractionated heparin was administered in 33 (87%) and thrombolytics in four (11%). The median hospital length of stay was 9 days. Two of 37 saddle pulmonary embolism patients (5.4%) died in the hospital (95% confidence interval 0.7% to 18%).
Most patients with saddle pulmonary embolism found on computed tomography angiography responded to the standard management for pulmonary embolism with unfractionated heparin. Although ominous in appearance, most patients with saddle pulmonary embolism are hemodynamically stable and do not require thrombolytic therapy or other interventions.
鞍状肺栓塞代表着大量的血栓和突然发生血流动力学崩溃的风险。然而，临床表现和结果差异很大。根据超声心动图、计算机断层扫描血管造影或心肌酶升高的右心功能障碍的发现，一些人主张即使对于血流动力学稳定的患者，也使用溶栓剂或导管血栓切除术。
研究鞍状肺栓塞患者的结局和处理方法，包括影像学表现（估计血栓负荷）和超声心动图特征。
无。
这项研究是对 2004 年 6 月 1 日至 2009 年 2 月 28 日期间所有计算机断层扫描血管造影显示肺栓塞阳性的患者进行的回顾性评估。两位放射科医生选择了那些有鞍状肺栓塞的患者，并评估了血栓负荷评分。通过病历回顾提取了这些患者的临床信息、超声心动图、治疗和结局。在 680 例有记录的肺栓塞患者中，有 37 例（5.4%，95%置信区间 4%至 7%）在计算机断层扫描血管造影中发现鞍状肺栓塞。对于有鞍状肺栓塞的患者，中位年龄为 60 岁，41%为男性。主要合并症为神经系统疾病（24%）、近期手术（24%）和恶性肿瘤（22%）。一过性低血压发生在 14%的患者中，持续性休克发生在 8%的患者中。有 1 例患者需要机械通气。对 27 例患者（73%）进行了超声心动图检查。78%的患者存在右心室扩大和功能障碍，67%的患者存在肺动脉收缩压升高。计算机断层扫描血管造影显示中等程度的肺动脉血栓负荷评分中位数为 31 分。右心室与左心室直径比中位数为 1.39。46%的患者放置了下腔静脉滤器。33 例（87%）患者接受了未分级肝素治疗，4 例（11%）患者接受了溶栓治疗。中位住院时间为 9 天。37 例鞍状肺栓塞患者中有 2 例（5.4%）在医院死亡（95%置信区间 0.7%至 18%）。
大多数在计算机断层扫描血管造影上发现的鞍状肺栓塞患者对肺栓塞的标准治疗方案（未分级肝素）反应良好。尽管鞍状肺栓塞的表现令人担忧，但大多数患者血流动力学稳定，不需要溶栓治疗或其他干预措施。
