Department of Intensive Care, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
EuroIntervention. 2018 Jun 20;14(2):238-246. doi: 10.4244/EIJ-D-17-00544.
The aim of this study was to evaluate the effectiveness of local low-dose urokinase thrombolysis (LLDUT) in haemodynamically stable pulmonary embolism with right ventricular dysfunction (RVD).
This was a prospective study. LLDUT with a 200,000 IU bolus followed by a 100,000 IU/hr infusion was given. Treatment duration was determined through radiological control performed 48-72 hrs into treatment. A follow-up echocardiogram was performed within seven days after LLDUT completion. Evolution of thrombus burden, pulmonary artery pressures (PAP) and RVD were studied, and haemorrhagic complications and mortality were recorded. Eighty-seven patients were included (62.5±16.5 years). In 67 patients (77%), the baseline echocardiogram showed mild-to-severe RVD, a dilated right ventricle (diameter: 44.4±6.2 mm) and a decreased tricuspid annular plane systolic excursion (14 mm [12-17]). Seventy-six patients (87.4%) experienced radiological improvement. Initially high PAP (mmHg) decreased after LLDUT: systolic 52.4 vs. 35.2 (17.2 [95% CI: 14.5-19.9]; p<0.0001), mean 34.2 vs. 23.5 (10.7 [95% CI: 9.0-12.5]; p<0.0001) and diastolic 23.9 vs. 16.0 (7.9 [95% CI: 6.1-9.7]; p<0.0001). Follow-up echocardiography showed overall improvement of RVD. No life-threatening haemorrhagic complications were reported. Six-month survival was 96.5%.
LLDUT rapidly decreased thrombus burden and PAP, improving right ventricular function, and was not associated with any life-threatening complications or pulmonary embolism (PE)- or treatment-related mortality.
本研究旨在评估局部小剂量尿激酶溶栓（LLDUT）治疗伴有右心室功能障碍（RVD）的血流动力学稳定型肺栓塞的疗效。
这是一项前瞻性研究。给予 20 万 IU 负荷量后，再以 10 万 IU/小时的速度持续输注。通过治疗 48-72 小时时进行的影像学控制来确定治疗持续时间。在 LLDUT 完成后 7 天内进行后续超声心动图检查。研究了血栓负荷、肺动脉压（PAP）和 RVD 的变化，并记录了出血并发症和死亡率。共纳入 87 例患者（62.5±16.5 岁）。在 67 例（77%）患者中，基线超声心动图显示存在轻至重度 RVD、右心室扩张（直径：44.4±6.2mm）和三尖瓣环平面收缩期位移（TAPSE）降低（14mm[12-17]）。76 例（87.4%）患者影像学改善。LLDUT 后初始高 PAP（mmHg）降低：收缩压 52.4 降至 35.2（17.2[95%CI：14.5-19.9]；p<0.0001），平均压 34.2 降至 23.5（10.7[95%CI：9.0-12.5]；p<0.0001），舒张压 23.9 降至 16.0（7.9[95%CI：6.1-9.7]；p<0.0001）。随访超声心动图显示 RVD 整体改善。未报告有生命威胁的出血性并发症。6 个月生存率为 96.5%。
LLDUT 可迅速降低血栓负荷和 PAP，改善右心室功能，且与任何有生命威胁的并发症或肺栓塞（PE）或治疗相关的死亡率无关。
