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在稍尖的巨大的肺的栓塞的机械故障和 thrombolysis : 未来的试用

World Journal of Cardiology 2013年第5期5卷 141-147页

作者： Bishav Mohan Shibba Takkar Chhabra Naved Aslam Gurpreet Singh Wander Naresh kumar sood Sumati Verma Anil kumar Mehra Sarit Sharma Department of Cardiology Dayanand Medical College and Hospital Unit Hero DMC Heart Institute Ludhiana141001 Punjab India Dayanand Medical College and Hospital Ludhiana 141001 Punjab India Department of Medicine Keck School of Medicine LAC-USC Medical Center Los Angeles CA 90033 United States Department of Social and Preventive Medicine Dayanand Medical College and Hospital Ludhiana 141001 Punjab India

AIM: To assess role of combined modality of mechanical fragmentation and intralesional thrombolysis in patients with massive pulmonary embolism presenting subacutely. METHODS: Eight of 70 patients presenting in tertiary care centre of North India with massive pulmonary embolism within 4 years had subacute presentation (symptom onset more than 2 wk). These patients were subjected to pulmonary angiography with intention to treat basis via mechanical breakdown and intra lesional thrombolysis. Mechanical breakdown of embolus was accomplished with 5-F multipurpose catheter to reestablish flow, followed by intralesional infusion of urokinase (4400 IU/kg over 10 min followed by 4400 IU/kg per hour over 24 h). RESULTS: Eight patients, mean age 47.77±12.20 years presented with subacute pulmonary embolism (mean duration of symptoms 2.4 wk). At presentation, mean heart rate, shock index, miller score and mean pulmonary pressures were 101.5±15.2/min, 0.995±0.156, 23.87±3.76 and 37.62±6.67 mmHg which reduced to 91.5±12.2/min (P=0.0325), 0.789±0.139 (P=0.0019), 5.87±1.73 (P=0.0000004) and 27.75±8.66 mmHg (P=0.0003) post procedurally. Mean BP improved from 80.00±3.09 mmHg to 90.58±9.13 mmHg (P=0.0100) post procedurally. Minor complications in the form of local hematoma-minor hematoma in 1 (12.5%), and pseudoaneurysm (due to femoral artery puncture) in 1 (12.5 %) patient were seen. At 30 d and 6 mo follow up survival rate was 100% and all the patients were asymptomatic and in New York Heart Association class 1. CONCLUSION: Combined modality of mechanical fragmentation and intralesional thrombolysis appears to be a promising alternative to high risk surgical procedures in patients with subacute massive pulmonary embolism.

关键词： Mechanical breakdown Subacute Thrombolysis Thromboembolic Intra pulmonary Catheter directed

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