Clinical Comparative Study Of Therapeutic Effect Of Thrombolysis By Peripheral Venous System And DSA-guided Interventional Therapy In The Treatment Of Acute Fatal Pulmonary Embolism

Objective:To study the DSA guided transcatheter pulmonary mechanical broken bolt, thrombolysis and suction suppository(CDT), and compared with the therapeutic effect of peripheral venous system and the differences of two kinds of treatments. Methods:35 cases of patients with acute fatal pulmonary embolism, and on the basis of family will or the economy is divided into two groups, group A drug delivery system for the peripheral vein treatment group(control group), group B line for pulmonary embolism of interventional treatment group(team).A group of 20 cases, 15 cases of group B.Male 14 cases in group A, accounted for 70%, female 6 cases, accounting for 30%;Aged 22 to 77 years old, average(61 + /- 12.79).Men in the group B 8 cases, accounting for 53%, 7 cases, women accounted for 47%;Age 38-81, the average(64 + /- 12.81).All patients in two group were given braking, and maintain blood circulation when administering oxygen inhalation through nasal catheter mask double support treatment, such as loop unstable patients give necessary asoactie drugs in order to maintain the stability of vital signs, and strictly control the amount of the amount of fluids in order to avoid the maintain circulation right heart overload caused by too much, lead to heart failure.Close monitoring of blood pressure, heart rate, breathing, transcutaneous oxygen saturation and the changes of electrocardiogram(ecg).Two groups of patients were admitted to hospital routine physical and chemical inspection, D- dimer, myocardial enzymology and brain natriuretic peptide measurement.A group of patients after heart colour to exceed, the measurement of pulmonary artery pressure.Anticoagulation: two groups of patients were given anticoagulation, use in accordance with heparin Q12 h subcutaneously, the hospital told two groups of patients had oral, when cutting shaaban piece of 10 mg(1 / day).Two groups of patients were given other auxiliary drugs for reducing fiber, remove, improve circulation treatment, thrombolysis treatment: group A with urokinase via peripheral vein drip(saline 100 ml + urokinase 400000 u, 2 / day).Group B patients with pulmonary artery thrombolysis, broken bolt and bolt, postoperative continue giving urokinase(saline 100 ml + urokinase 400000 u, 2 / day).When discharged by CTPA or DSA imaging differences before and after treatment, clinical symptoms(shortness of breath, chest pain, dying) have improved and compared before and after treatment of heart rate, blood oxygen saturation, the change of the pulmonary artery pressure and treatment after patients CTPA or DSA imaging of pulmonary artery thrombosis were significantly reduced or disappeared, clinical symptoms were improved significantly, two groups of curative effect were significantly, statistical analysis and comparison before and after treatment of heart rate, blood oxygen saturation and the changes of pulmonary artery pressure. Results:All patients before discharge into the group review CTPA, compared with before treatment CTPA, pulmonary artery thrombosis were significantly reduced or disappeared.Treatment in 20 days, 35 patients with dyspnea symptoms were significantly improved, 12 cases of chest pain in patients with chest pain disappeared, 12 cases with dying patients has not been a dying again.Before via peripheral vein group and the treatment of catheter thrombolysis broken bolt treatment group two groups of patients with pulmonary artery pressure, heart rate and blood oxygen comparative differences had no statistical significance(p > 0.05).Via peripheral venous treatment group after treatment and broken bolt catheter thrombolysis treatment group blood oxygen than before treatment in both groups were elevated, the heart rate was reduced, the pulmonary artery pressure was reduced, the two groups before and after treatment comparison difference was statistically significant(p < 0.001).Catheter thrombolysis broken bolt in treatment group after treatment in patients with a via peripheral venous blood oxygen treatment group patients increased obviously, heart rate and pulmonary artery pressure patients decreased significantly compared with the via peripheral vein;Via peripheral venous treatment group after treatment and broken bolt catheter thrombolysis treatment group two groups of patients with pulmonary artery pressure, heart rate and blood oxygen comparative differences are statistically significant(p < 0.05).Group B 15 patients who have completed the pulmonary artery angiography, transcatheter pulmonary artery thrombolysis, broken bolt, among them 4 cases because of the inefficiency of pure broken bolt thrombolysis, use the guide catheter treating absorption at the same time.Technical success rate reached 100%.Two groups of patients with placed convertible type filter 11(both for 15 days), 6 cases of permanent filter.Each part of the complications: bleeding Periumbilical subcutaneously in 11 cases, heparin minor bleeding, 31.4%(11/35), venous blood in the subcutaneous mild bleeding in 5 cases(5/35), 14.2% did not give special treatment, skin infiltration to absorb blood, and group B punctured hemorrhage in 2 cases(2/15), 13.3% for the puncture point again oppression hemostasis, stop bleeding.There was no hemorrhage, cerebral hemorrhage, abdominal cavity hemorrhage and other important organs without cardiac rupture and pulmonary artery perforation.Group B ventricular arrhythmia happened in 3 patients, intraoperative catheter through the analysis of the right ventricle to ventricular wall stimulation, avoid catheter immediately disappear after contact with right ventricular wall.Two groups of patients with no serious complications occurred.31 patients with a mean follow-up of 8.2 months(1-14 months) follow-up rate of 88.5%(31/35).All patients accept telephone follow-up, the patient failed to check to the hospital, but simply follow-up related symptoms, can’t get such as CTPA, echocardiography, pulmonary arterial pressure, heart rate and blood oxygen saturation, etc.All patients receiving follow-up said did not appear again again, difficulty breathing, chest tightness, chest pain, the symptom such as dying, all patient follow-up period to survive, the follow-up to continue. Conclusion:1, For the treatment of acute fatal pulmonary embolism, whether via peripheral venous thrombolysis treatment or DSA guidance of interventional treatment of pulmonary embolism, effective treatments.2, Under the guide of interventional treatment of pulmonary embolism is via peripheral venous thrombolysis treatment more positive and effective.