[导管辅助局部溶栓疗法治疗亚大块肺栓塞]。

Innere Medizin (Heidelberg, Germany) Pub Date : 2024-09-01 Epub Date: 2024-07-09 DOI:10.1007/s00108-024-01736-w
Rainer Waßmer, Marie Koch, Evelyn Trips, Matthias Filz, Claudia Bräsel, Martin Meister, Xina Grählert, Torsten Fuß
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摘要

背景:肺栓塞是第三大常见心血管疾病:肺栓塞是第三大常见心血管疾病。近年来,作为全身溶栓治疗的替代方案,介入治疗在治疗血流动力学稳定的亚肿块型肺栓塞方面得到了前所未有的创新。治疗方法多种多样,大致可分为局部溶栓和局部血栓切除术。多年来,我们中心一直使用侧孔溶栓导管进行导管辅助局部溶栓治疗,并在15小时内对血流动力学稳定的亚严重肺栓塞患者每个肺动脉分支累计注射10毫克阿替普酶:研究包括2018年1月至2023年3月的数据。为此,根据 OPS 编码(8.838.60 和 1-276.0)选择患者,并通过病历收集数据。生物特征数据、既往疾病和生命参数数据、实验室化学数据、CT 诊断数据、超声心动图数据、药物治疗数据和并发症数据均以匿名方式收集:右心负荷明显减轻。结果:右心负荷明显减轻,外周血氧饱和度明显改善,心率明显下降。并发症发生率仍然很低,而且几乎仅限于与入路相关的问题:结论:导管辅助局部溶栓疗法是治疗亚大块肺栓塞的一种安全有效的方法。
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[Catheter-assisted local lysis therapy for submassive pulmonary embolism].

Background: Pulmonary embolism is the third most common cardiovascular disease. Interventional treatment options as an alternative to systemic lysis therapy of hemodynamically stable, submassive pulmonary embolisms have received an unprecedented boost in innovation in recent years. The treatment options are heterogeneous and can be roughly divided into local thrombolysis and local thrombectomy. For years in our center we have been carrying out catheter-assisted, locoregional lysis therapy with side-hole lysis catheters and a cumulative dose per pulmonary branch of 10 mg alteplase over 15 h for hemodynamically stable, submassive pulmonary emboli.

Aim: The aim of this retrospective study was to review this therapeutic concept and to collect data on clinical endpoints and possible complications.

Methods: The study included data from 01/2018-03/2023. For this purpose, the patients were selected based on the OPS codes (8.838.60 and 1‑276.0), and the data was collected using the medical records. Biometric data, data on previous illnesses and vital parameters, laboratory chemistry data, CT diagnostic data, echocardiographic data, data on drug treatment and data on complications were collected anonymously.

Results: There was a significant reduction in the strain on the right heart. Peripheral oxygen saturation also improved significantly and heart rate decreased significantly. The complication rate remained low and was almost exclusively limited to access-related problems.

Conclusion: Catheter-assisted, locoregional lysis therapy is a safe and effective treatment method for submassive pulmonary embolism.

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