在患有中等和高风险肺栓塞的患者中,当代的再注射疗法
Burton H Shen1, Divya A Shankar1, Nicholas A Bosch1
1Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
Thrombosis research
|November 1, 2025
概括
对于肺栓塞 (PE) 的再输液疗法使用情况各不相同. 机械血栓切除术的采用增加了,但它取代了导管导向的血栓溶解,但没有提高中等和高风险PE患者的整体转血率.
科学领域:
- 心脏病学 心脏病学
- 干预性肺病学 干预性肺病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 对于中等和高风险肺栓塞 (PE) 的再注射疗法的当代指导方针缺乏,这导致了显著的实践变化.
- 这项研究调查了用于PE的全身血栓溶解,导管导向血栓溶解和机械血栓切除的变异性和趋势.
- 它还研究了机械血栓切除术的采用后医院实践如何发展.
研究的目的:
- 评估用于中期和高风险PE的不同再注射疗法的医院间的差异.
- 分析2016年至2022年这些疗法的使用时间趋势.
- 评估采用机械血栓切除术对使用其他再输血方法的影响.
主要方法:
- 利用国家Premier Inc.人工智能数据库 (2016-2022) 识别中等风险或高风险PE的成年患者.
- 计算了类内相关系数 (ICCs) 来量化每种治疗的医院间变化.
- 采用等级回归和中断时间序列分析来评估趋势和采用影响.
主要成果:
- 在这两组风险人群中,观察到管导向血栓溶解 (ICC 23.1-23.8%) 和血栓切除 (ICC 25.1-35.4%) 的高使用差异.
- 机械血栓切除术的使用率从2016年的0.6%显著增加到2022年的14.3% (p < 0.001).
- 采用机械血栓切除术的医院显示,导管式血栓溶解使用的速度有所减缓,整体转流治疗率没有增加.
结论:
- 在美国,对于中等风险和高风险PE患者的再注射疗法使用存在显著差异.
- 机械血栓切除术的采用已经大幅增加,但似乎取代了,而不是补充了导管导向的血栓溶解.
- 调查结果强调了对护理标准化,优化资源配置和进一步调查患者结果的需求.
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