Li Fei, Su Zhengxian, Fu Chuntao, Wang Qing, Wang Xiang, Zhang Jiecheng, Yanagiya Masahiro, Zhao Wenjun
Department of Vascular Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China.
Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China.
J Thorac Dis. 2024 Nov 30;16(11):7797-7806. doi: 10.21037/jtd-24-1690. Epub 2024 Nov 29.
Patients with acute and high-risk pulmonary embolism have a high mortality rate, and the optimal treatment for these patients has still not been fully established. Although anticoagulation therapy is currently the preferred treatment for pulmonary embolism, for some patients with intermediate- or high-risk pulmonary embolism, anticoagulation therapy alone has a higher probability of long-term pulmonary hypertension and also seriously worsens the quality of life of patients. This paper mainly reports the efficacy and safety of percutaneous mechanical thrombectomy (PMT) in patients with acute medium- or high-risk pulmonary embolism in Taizhou Hospital of Zhejiang Province so as to provide some clinical basis for the treatment of such patients in the future.
This study mainly collected the clinical data of 43 patients who were admitted to Taizhou Hospital of Zhejiang Province from May 2018 to May 2023 due to acute medium-to-high-risk pulmonary embolism and received PMT treatment. Preoperative and postoperative blood tests, vital signs, and echocardiographic parameters were compared. The incidence of intraoperative and postoperative complications in follow-up at 1, 6, and 12 months was also recorded. Mechanical treatment included thrombus fragmentation complemented with aspiration.
Among the 43 patients, 22 patients were treated with thrombus fragmentation coupled with a pigtail catheter and aspiration using a 6-F multipurpose angiographic (MPA) catheter, 11 were treated by AngioJet, and 10 were treated with an AcoStream catheter. Local thrombolysis treatment with small dose of urokinase was administered in some patients according to the patient's risk of bleeding. Among the patients, 41 patients received a successful operation, representing a surgical success rate of 95.3%. There was one patient with pulmonary infection who died after discharge. There were significant differences in vital signs between the 48-hour preoperative timepoint and the 48-hour postoperative timepoint including cardiac index, pulse, mean arterial pressure, and oxygen saturation (P<0.001). The blood test indicators of carbon dioxide partial pressure and creatinine level did not show obvious abnormalities, but differences in hemoglobin, oxygen partial pressure, and lactate level were statistically significant. In terms of cardiac ultrasound, pulmonary artery pressure and right atrial diameter change were significantly different (P<0.001). There were seven cases of local hematoma at the puncture site, three cases of infection at the puncture site, and nine cases of transient cardiac arrest during the operation. All 41 patients were followed up: one patient died after being discharged due to aggravation of pulmonary infection during hospitalization, one patient died of intracerebral hemorrhage 9 months after the operation, one patient developed recurrent pulmonary embolism, and five patients had no obvious improvement in chest tightness.
PMT can be used as a safe and effective treatment option for acute medium-to-high-risk pulmonary embolism.
急性高危肺栓塞患者死亡率高，此类患者的最佳治疗方案尚未完全确立。尽管抗凝治疗目前是肺栓塞的首选治疗方法，但对于一些中高危肺栓塞患者，单纯抗凝治疗发生长期肺动脉高压的概率较高，且严重影响患者生活质量。本文主要报道浙江省台州医院对急性中高危肺栓塞患者采用经皮机械血栓清除术（PMT）的疗效及安全性，为今后此类患者的治疗提供一定临床依据。
本研究主要收集了2018年5月至2023年5月因急性中高危肺栓塞入住浙江省台州医院并接受PMT治疗的43例患者的临床资料。比较术前和术后的血液检查、生命体征及超声心动图参数。记录随访1个月、6个月和12个月时术中及术后并发症的发生率。机械治疗包括血栓破碎辅以抽吸。
43例患者中，22例采用血栓破碎联合猪尾导管并使用6F多用途血管造影（MPA）导管抽吸治疗，11例采用AngioJet治疗，10例采用AcoStream导管治疗。部分患者根据出血风险给予小剂量尿激酶局部溶栓治疗。43例患者中，41例手术成功，手术成功率为95.3%。1例患者出院后死于肺部感染。术前48小时与术后48小时生命体征包括心脏指数、脉搏、平均动脉压和血氧饱和度有显著差异（P<0.001）。血液检查指标中二氧化碳分压和肌酐水平未见明显异常，但血红蛋白、氧分压和乳酸水平差异有统计学意义。心脏超声方面，肺动脉压和右心房直径变化差异有统计学意义（P<0.001）。穿刺部位局部血肿7例，穿刺部位感染3例，术中短暂心脏骤停9例。41例患者均获随访：1例患者出院后因住院期间肺部感染加重死亡，1例患者术后9个月死于脑出血，1例患者发生复发性肺栓塞，5例患者胸闷无明显改善。
PMT可作为急性中高危肺栓塞安全有效的治疗选择。
