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首页> 外文期刊>Journal of cardiac surgery. >Improvements in Pulmonary Artery Pressure and Right Ventricular Function After Ultrasound-Accelerated Catheter-Directed Thrombolysis for the Treatment of Pulmonary Embolism
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Improvements in Pulmonary Artery Pressure and Right Ventricular Function After Ultrasound-Accelerated Catheter-Directed Thrombolysis for the Treatment of Pulmonary Embolism

机译：超声加速导管定向溶栓治疗肺栓塞后肺动脉压力和右心室功能的改善

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Objective: To evaluate the efficacy of ultrasound-accelerated catheter-directed thrombolysis (UACDT) in the treatment of patients with massive and submassive pulmonary embolism (PE). Method: Twenty-two patients (13 males and nine females; age range, 38 to 71 years; mean age, 53.7 years) with massive or submassive PE were treated with UACDT with the EKOS EkoSonic (R) system. All patients exhibited acute symptoms, computed tomography (CT) evidence of large thrombus burden, and evidence of right ventricular (RV) dysfunction and/or failure. Clinical outcomes and complications, RV pressures, and thrombus clearance were evaluated. Results: Treatment of 22 patients resulted in complete thrombus clearance (>= 90%) in 77.2% of the patients, and near-complete (50% to 90%) clearance in 22.8%. The median tissue plasminogen activator (tPA) dose for all patients in our study was 21.0mg (range 16 to 35 mg) and the median infusion time was 20.5 hours (range 12 to 28 hours). Measurements before and after treatment showed a decrease in pulmonary artery pressure (67 +/- 14 to 34 +/- 11 mmHg [systolic], p<0.001). The RV/LV ratio decreased from 1.29 +/- 0.17 to 0.92 +/- 0.11 at follow-up (p<0.001). Modified Miller score was significantly reduced (from 28 +/- 4 to 13 +/- 5, p<0.001) in 21 of 22 (95%) patients who survived to discharge. There were only two minor access site bleeding complications, neither requiring transfusion. Conclusion: This study demonstrates safety and effectiveness of UACDT in patients with acute PE with a large thrombus burden.
机译：目的：评价超声加速导管定向溶栓术（UACDT）在治疗大面积和亚大规模肺栓塞（PE）患者中的疗效。方法：采用EKOS EkoSonic（R）系统对UACDT进行治疗的22例大块或亚块性PE患者（男13例，女9例;年龄范围38至71岁;平均年龄53.7岁）。所有患者均表现出急性症状，计算机断层扫描（CT）证据表明血栓负担沉重以及右心室（RV）功能障碍和/或衰竭。评估临床结果和并发症，右室压力和血栓清除率。结果：22例患者的治疗导致77.2％的患者血栓完全清除（> = 90％），而22.8％的患者接近完全血栓清除（50％至90％）。在我们的研究中，所有患者的组织纤溶酶原激活剂（tPA）的中位剂量为21.0mg（范围为16至35mg），中位输注时间为20.5小时（范围为12至28小时）。治疗前后的测量结果显示肺动脉压降低（收缩压67 +/- 14至34 +/- 11 mmHg，p <0.001）。随访时RV / LV比从1.29 +/- 0.17降低至0.92 +/- 0.11（p <0.001）。在22例（95％）存活出院的患者中，改良的Miller评分显着降低（从28 +/- 4降至13 +/- 5，p <0.001）。只有两个轻微的进入部位出血并发症，都不需要输血。结论：这项研究证明了UACDT在急性PE患者中具有大量血栓负担的安全性和有效性。

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