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高危肺栓塞的机械支持:综述文章

Mechanical Support in High-Risk Pulmonary Embolism: Review Article.

作者信息

Kadri Amer N, Alrawashdeh Razan, Soufi Mohamad K, Elder Adam J, Elder Zachary, Mohamad Tamam, Gnall Eric, Elder Mahir

机构信息

Divion of Cardiovascular Medicine, Main Line Health, Lankenau Medical Center, Wynnewood, PA 19096, USA.

Department of Medicine, Faculty of Medicine, University of Jordan, Amman 11942, Jordan.

出版信息

J Clin Med. 2024 Apr 24;13(9):2468. doi: 10.3390/jcm13092468.

Abstract

Acute pulmonary embolism (PE) may manifest with mild nonspecific symptoms or progress to a more severe hemodynamic collapse and sudden cardiac arrest. A substantial thrombotic burden can precipitate sudden right ventricular strain and failure. Traditionally, systemic thrombolytics have been employed in such scenarios; however, patients often present with contraindications, or these interventions may prove ineffective. Outcomes for this medically complex patient population are unfavorable, necessitating a compelling argument for advanced therapeutic modalities or alternative approaches. Moreover, patients frequently experience complications beyond hemodynamic instability, such as profound hypoxia and multiorgan failure, necessitating assertive early interventions to avert catastrophic consequences. The existing data on the utilization of mechanical circulatory support (MCS) devices are not exhaustive. Various options for percutaneous MCS devices exist, each possessing distinct advantages and disadvantages. There is an imminent imperative to develop a tailored approach for this high-risk patient cohort to enhance their overall outcomes.

摘要

急性肺栓塞(PE)可能表现为轻微的非特异性症状,或进展为更严重的血流动力学崩溃和心搏骤停。大量血栓负荷可促使右心室突然应变和衰竭。传统上,在这种情况下会使用全身溶栓药物;然而,患者常常存在禁忌证,或者这些干预措施可能无效。对于这一医学情况复杂的患者群体,预后不佳,因此迫切需要有力论据支持先进的治疗方式或替代方法。此外,患者经常会出现血流动力学不稳定之外的并发症,如严重缺氧和多器官功能衰竭,这就需要果断进行早期干预以避免灾难性后果。关于机械循环支持(MCS)设备使用的现有数据并不详尽。经皮MCS设备有多种选择,每种都有其独特的优缺点。迫切需要为这一高危患者群体制定一种量身定制的方法,以改善他们的总体预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/993c/11084514/6e78852cc2d2/jcm-13-02468-g001.jpg

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