综合介入治疗高危肺栓塞合并下肢深静脉血栓的临床疗效评价与应用价值研究

doi:10.3969/j.issn.1006-6233.2017.09.021

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摘要 目的: 探讨综合介入治疗在高危肺栓塞合并下肢深静脉血栓中应用的临床疗效与价值。方法: 选取确诊高危肺栓塞合并下肢深静脉血栓的患者14例,采用综合介入治疗方法,在下腔静脉滤器保护下行肺动脉、下肢深静脉造影,并通过导管机械性处理和置管溶栓开通肺动脉和下肢深静脉,观察临床症状、体征、血流动力学改变、血管开通情况以及有无并发症。结果: 所有患者临床症状均明显缓解。术前休克指数和动脉血氧分压分别为(0.95±0.09)和(69.7±7.2)mmHg,术后1d分别为(0.74±0.22)和(80.6±1.2)mmHg,与治疗前比较差异均有统计学意义(P<0.01)。术前肺动脉收缩压与Miller评分分别为(57.2±8.5)mmHg和(18.3±3.1),术后7d分别为(32.7±2.9)mmHg和(3.4±2.5),术后14d分别为(27.7±3.4)mmHg和(2.1±2.4),与治疗前比较均差异有统计学意义(P<0.01)。除1例血尿外,无严重手术并发症发生。结论: 综合介入治疗对高危肺栓塞合并下肢深静脉血栓的患者是一种安全,迅速,有效的治疗方法,值得推广。

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关键词 ：高危肺栓塞, 下肢深静脉血栓, 综合介入治疗, 疗效

Abstract：Objective: To evaluate the clinical efficacy and application value of comprehensive interventional treatment for severe pulmonary embolism with deep vein thrombosis.Methods: 14 patients confirmed with severe pulmonary embolism with deep vein thrombosis were treated by comprehensive interventional therapy. Pulmonary arteriography and lower extremity phlebography were performed after placement of inferior vena cava filter, opened the pulmonary artery and deep vein of lower limb through the catheter mechanical processing and catheter thrombolysis. Clinical manifestations, hemodynamic changes, the recanalization of obstructed blood vessels as well as the occurrence complications were observed. Results: Improvement in clinical symptoms was achieved in all cases. The shock index and arterial partial pressure of oxygen before and 1d of procedure were(0.95±0.09)vs(0.74±0.22)(P<0.01), (69.7±7.2)mmHg vs(80.6±1.2)mmHg(P<0.01), the pulmonary artery systolic pressure and Miller score before ,7d and 14d of procedure were(57.2±8.5)mmHg vs(32.7±2.9)mmHg vs(27.7±3.4)mmHg(P<0.01),(18.3±3.1)vs(3.4±2.5)vs(2.1±2.4)(P<0.01). Except for hematuria in 1 case, there were no other severe surgical complications occurred. Conclusion: Comprehensive interventional treatment for severe pulmonary embolism with deep vein thrombosis is a safe, rapid, effective method and worth promoting.

Key words： Severe pulmonary embolism Deep venous thrombosis Comprehensive interventional therapy Efficacy

基金资助:2015年政府资助临床优秀人才项目

引用本文:

张青云, 丁萌, 陈磊, 高建国, 杨植. 综合介入治疗高危肺栓塞合并下肢深静脉血栓的临床疗效评价与应用价值研究[J]. 河北医学, 2017, 23(9): 1480-1483.
ZHANG Qingyun, DING Meng, CHEN Lei, et al. The Clinical Efficiency and Application Study of Comprehensive Interventional Treatment for Severe Pulmonary Embolism with Deep Vein Thrombosis. 河北医学, 2017, 23(9): 1480-1483.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2017.09.021 或 http://www.hbyxzzs.cn/CN/Y2017/V23/I9/1480

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