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机械血栓切除与用于肺栓塞的导管导向血栓溶解的元分析
Sahib Singh1, Kevin Bliden2, Udaya S Tantry2
1Department of Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland, USA.
概括
肺栓塞 (PE) 的机械血栓切除 (MT) 显示出更长的程序时间,但与导管导向血栓溶解 (CDT) 相比,重症监护室 (ICU) 住院率较低,ICU 停留时间较短. CDT的速度更快,流血量更少,但导致ICU利用率更高.
科学领域:
- 干预心脏病学 干预心脏病学
- 肺部医学 肺部医学
- 关键护理医学 关键护理医学
背景情况:
- 对肺栓塞 (PE) 的导管干预具有不同的结果.
- 机械血栓切除 (MT) 和导管导向血栓溶解 (CDT) 是常见的治疗选择.
- 需要进行比较的元分析来澄清治疗疗效.
研究的目的:
- 在肺栓塞 (PE) 患者中,比较机械血栓切除 (MT) 与导管导向血栓溶解 (CDT) 的结果.
- 评估MT和CDT之间的关键程序和临床终点.
- 为PE管理中最佳治疗选择提供证据.
主要方法:
- 一项对10项研究进行系统的元分析,比较PE的MT和CDT.
- 评估的结果包括手术时间,光镜持续时间,血流,血液动力学变化 (mPAP,RV/LV比率),ICU入院率,入院时间和不良事件 (ICH,出血,死亡率,再入院).
- 计算了 95% 置信区间 (CI) 的聚合赔率比率 (OR) 和标准化平均差异 (SMD).
主要成果:
- 机械血栓切除术 (MT) 与导管导向血栓溶解 (CDT) 相比,与明显更长的手术时间,光镜持续时间和估计的血液损失有关.
- 然而,MT证明了术后重症监护室 (ICU) 入院率显著降低,ICU停留时间更短.
- 对于血液动力学变化,住院时间,内出血,严重出血,死亡率或再入院率,MT和CDT之间没有显著差异.
结论:
- 导管血栓溶解 (CDT) 是一个更快的程序,在肺栓塞 (PE) 治疗中流失较少的血液.
- 机械血栓切除术 (MT) 在减少重症监护室 (ICU) 入院率和停留时间方面提供了显著的好处.
- 在PE的MT和CDT之间进行选择时,应考虑程序效率和程序后资源利用之间的权衡.
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