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目的探讨应用局部血栓捣碎并溶栓方法治疗超过溶栓的时间窗(2周)的肺动脉栓塞的疗效。方法观察2例大块或次大块肺栓塞患者,病程均超过2周,应用局部血栓捣碎并溶栓方法治疗,前后行肺动脉造影、测压对比,观察心脏杂音、超声心动图、心电图和核素显像变化。结果患者1左右肺各有一肺段恢复充盈,肺动脉听诊区第二心音分裂消失。患者2右肺中叶内段和下叶前基底段充盈明显改善,肺动脉主干压降低;右房室正常,三尖瓣区SM杂音明显减轻,心电图“SⅠQⅢ消失”;症状明显缓解。结论肺动脉局部血栓捣碎+溶栓术可能对病程超过2周的PE患者有效。
Objective To investigate the efficacy of local thrombolysis and thrombolysis in the treatment of pulmonary embolism over a thrombolytic time window (2 weeks). Methods Two patients with massive or sub-massive pulmonary embolism were enrolled. The course of disease was over two weeks. Local thrombolysis and thrombolysis were performed. Pulmonary arteriography and manometry were performed before and after contrast. Heart murmur, echocardiography, electrocardiogram Nuclide imaging changes. Results There was a pulmonary fistula in each of the left and right lungs, and the second heart sound disappeared in the pulmonary auscultation area. Patients 2 right middle lobe of the middle and lower lobe anterior segment of the base filling significantly improved filling, pulmonary artery pressure decreased; right atrioventricular tachycardia SM noise was significantly reduced ECG “S Ⅰ Q Ⅲ disappeared”; symptoms were relieved. Conclusion Pulmonary arterial thrombolysis and thrombolysis may be effective in patients with PE over 2 weeks.