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高和中高风险肺栓塞的管理:一个5年的重症监护病房病例性审查
Inês Mendonça1, Sara Teixeira1, Ana Rita Ferreira1
1Intensive Care Medicine, Centro Hospitalar e Universitário São João, Porto, Portugal.
Portuguese journal of cardiac thoracic and vascular surgery
|January 17, 2025
概括
高风险肺栓塞 (PE) 的最佳管理仍在争论中. 系统性血栓溶解显示高风险PE的生存率高于VA-ECMO,而单独的肝素对中等高风险PE有效.
科学领域:
- 关键护理医学 关键护理医学
- 心脏病学 心脏病学
- 肺部医学 肺部医学
背景情况:
- 高风险和中高风险肺栓塞 (PE) 的最佳管理策略尚未确定.
- 这项研究解决了围绕这些患者群体最佳治疗方法的持续辩论.
研究的目的:
- 评估高风险和中高风险PE在重症监护病房 (ICU) 的各种治疗方法的短期和长期临床结果.
- 为了确定在严重PE病例的管理中需要改进的领域.
主要方法:
- 从2018年1月到2023年12月,64名患有高风险或中高风险PE的患者被录入ICU的回顾性分析.
- 评估治疗方法,包括全身血栓溶解 (ST),静脉动脉外体膜氧化 (VA-ECMO),导管导向疗法和单独的肝素.
- 评估的临床结果包括ICU和28天存活率,停留时间,主要出血并发症和肺高血压 (PHT) 的迹象.
主要成果:
- 对于高风险PE (n=32),全身血栓溶解 (n=18) 产生了83.0%的ICU/28天生存率,而VA-ECMO + ST (n=6) 则为66.67%,VA-ECMO单独 (n=5) 则为60.0%.
- 在接受ST或VA-ECMO + ST治疗的10名患者中发生了严重的出血并发症.
- 对于中等高风险PE (n=32),单独的肝素 (90%的病例) 导致97%的ICU/28天生存率,在随访期间有3名患者发展PHT.
结论:
- 与基于VA-ECMO的策略相比,系统性血栓溶解似乎为高风险PE提供了更好的生存结果.
- 单独的氨酸证明了对中等高风险PE的高疗效和安全性.
- 需要进一步的研究来确定中等高风险PE中的特定子组,这些子组可能会从先进疗法中受益.
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