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目的 分析急性大面积肺血栓栓塞症 (PTE)患者溶栓治疗后的远期预后。方法 对2 60例急性PTE患者进行溶栓治疗并随访 ,分析其临床资料及引起远期临床事件 [死亡、再发深静脉血栓形成、再发PTE、慢性血栓栓塞性肺动脉高压和 (或 )右心衰竭、抗凝治疗出现大出血、依赖家庭氧疗 ]的危险因素。结果 2 60例PTE患者在住院期间死亡 2 2例 (8 5 % ) ,其中 1 5例 (62 8% )死于PTE。随访 2 2 7例患者 ,为期 3 9～ 8 4年 ,死亡 72例 (31 7% ) ,其中有 2 1例患者死于再发PTE。对随访资料完整的 1 65例患者进行远期临床事件的危险因素分析 ,单因素分析显示 ,既往有血栓栓塞病史、抗凝治疗不足 6个月、植入下腔静脉滤器、溶栓后超声心动图仍显示右室功能障碍和 (或 )扩大、溶栓后超声多普勒仍测得肺动脉收缩压 >50mmHg、出院前核素肺通气 /灌注扫描显示肺血管床阻塞 >30 %与远期临床事件的发生相关 ;多变量分析显示 ,溶栓后超声心动图仍显示右室功能障碍和 (或 )扩大、溶栓后超声多普勒仍测得肺动脉收缩压 >50mmHg、出院前核素肺通气 /灌注扫描显示肺血管床阻塞 >30 %是PTE远期预后的独立危险因素。结论 通过高危因素的确立 ,可予患者更积极的治疗 ,改善患者的预后
Objective To analyze the long-term prognosis of patients with acute massive pulmonary thromboembolism (PTE) after thrombolysis. Methods Twenty-six patients with acute PTE were treated with thrombolysis and follow-up. The clinical data were analyzed and the long-term clinical events such as death, recurrence of deep venous thrombosis, recurrent PTE, chronic thromboembolic pulmonary hypertension and / or right Heart failure, bleeding due to anticoagulant therapy, dependence on home oxygen therapy]. Results Twenty-two PTE patients died during hospitalization, 22 (85%) died, of which 15 (62.8%) died of PTE. A total of 227 follow-up cases were performed, ranging from 39 to 84 years, with 72 deaths (31.7%), of which 21 died of recurrent PTE. One hundred and sixty-five patients with complete follow-up data were analyzed for risk factors of long-term clinical events. Univariate analysis showed that patients with previous history of thromboembolism and anticoagulant therapy were less than 6 months and were implanted with inferior vena cava filters. Echocardiography after thrombolysis Figure still shows right ventricular dysfunction and / or enlargement, pulmonary artery systolic pressure> 50 mmHg still measured by thromboembolism after thrombolysis, and radionuclide perfusion scan of the radionuclide before perfusion showed> 30% pulmonary vascular bed obstruction and long-term clinical Multivariable analysis showed that echocardiography after thrombolysis still showed right ventricular dysfunction and / or enlargement, pulmonary artery systolic pressure was still> 50mmHg after ultrasonic thrombolysis, and radionuclide pulmonary ventilation / Perfusion scans showed pulmonary vascular bed obstruction> 30% was an independent risk factor for long-term prognosis of PTE. Conclusion Through the establishment of risk factors, patients can be more aggressive treatment to improve the prognosis of patients