Department of Research, St. Mary Mercy Hospital, Livonia, MI 48154, USA.
Am J Med. 2012 May;125(5):471-7. doi: 10.1016/j.amjmed.2011.12.003.
There are insufficient data to assess the potential role of pulmonary embolectomy in patients with acute pulmonary embolism.
In-hospital all-cause case fatality rate with pulmonary embolectomy was assessed from the Nationwide Inpatient Sample from 1999 through 2008.
Among unstable patients (in shock or ventilator-dependent), case fatality rate with embolectomy was 380 of 950 (40%). Among stable patients, case fatality rate was lower: 690 of 2820 (24%) (P <.0001). Case fatality rate in unstable patients was 39% in 1999-2003 and 40% in 2004-2008 (not significant), and in stable patients it was 27% in 1999-2003 and 23% in 2004-2008 (P=.01). Case fatality rates were lower in patients with a primary diagnosis of pulmonary embolism and even lower in patients with a primary diagnosis who had none of the comorbid conditions listed in the Charlson Index. Within each stratified group, patients with vena cava filters had a lower case fatality rate.
Case fatality rate in unstable patients who underwent pulmonary embolectomy remained at 39%-40% from 1999-2003 to 2004-2008, and in stable patients it decreased only from 27% to 23%. Case fatality rates were lower in those with fewer comorbid conditions and in those who received a vena cava filter. Our data reflect average outcome in the US. It may be that experienced surgeons and an aggressive multidisciplinary team could obtain a lower case fatality rate.
目前评估急性肺栓塞患者行肺动脉血栓切除术的潜在作用的数据不足。
从 1999 年至 2008 年的全国住院患者样本中评估了肺动脉血栓切除术患者的院内全因病死率。
在不稳定患者（休克或呼吸机依赖）中，行血栓切除术的病死率为 950 例中的 380 例（40%）。在稳定患者中，病死率较低：2820 例中的 690 例（24%）（P<.0001）。不稳定患者的病死率在 1999-2003 年为 39%，在 2004-2008 年为 40%（无显著差异），而在稳定患者中，该病死率在 1999-2003 年为 27%，在 2004-2008 年为 23%（P=.01）。患有原发性肺栓塞的患者病死率较低，甚至在没有 Charlson 指数所列合并症的原发性肺栓塞患者中病死率更低。在每个分层组内，放置下腔静脉滤器的患者病死率更低。
1999-2003 年至 2004-2008 年期间，行肺动脉血栓切除术的不稳定患者病死率仍保持在 39%-40%，而稳定患者病死率仅从 27%降至 23%。合并症较少的患者和接受下腔静脉滤器的患者病死率更低。我们的数据反映了美国的平均结果。可能是经验丰富的外科医生和积极的多学科团队能够获得更低的病死率。
