在大规模肺栓塞中,导管干预与外科栓塞术对比
Hind Anan1, Pamela El Hayek1, Fanny Alie-Cusson2
1Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Journal of vascular surgery. Venous and lymphatic disorders
|December 18, 2025
概括
导管干预 (CDI) 和外科栓塞切除 (SE) 显示大规模肺栓塞 (PE) 的存活率相似. CDI提供了更短的ICU停留时间和更少的重大出血事件,使其成为一个可行的替代方案.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 肺部医学 肺部医学
背景情况:
- 大规模肺栓塞 (PE) 治疗指南通常有利于系统性血栓溶解 (stPA).
- 手术栓塞切除 (SE) 和导管干预 (CDI) 是不适合或对stPA无反应的PE患者的替代方案.
- 有限的研究比较了CDI和SE在大规模PE中的结果.
研究的目的:
- 在患有大规模肺栓塞 (PE) 的患者中,比较导管干预 (CDI) 与手术栓塞 (SE) 的结果.
- 评估大量PE的CDI和SE之间的住院结果,长期死亡率和并发症率.
主要方法:
- 在2010年至2024年期间,对99名大规模PE患者进行了回顾性审查,这些患者接受了CDI (n=75) 或SE (n=24) 治疗.
- 分析包括基线特征,住院结果和长期死亡率.
- 统计方法包括卡普兰-梅尔生存曲线和多变量考克斯回归.
主要成果:
- 在CDI和SE组之间生存率没有显著差异.
- 与SE相比,CDI与显著缩短重症监护室 (ICU) 停留时间 (LOS) 和较少的重大出血并发症有关.
- 在CDI (21.3%) 和SE (20.8%) 之间,住院死亡率相似. 程序类型不是死亡率的重要预测因素.
结论:
- 导导管干预 (CDI) 是针对大规模PE的外科栓塞切除 (SE) 的最小侵入性替代方案,提供可比的生存结果.
- 与SE相比,CDI具有优势,包括减少ICU停留时间和较低发生重大出血并发症.
- CDI代表了大量PE的安全和有效的治疗选择,特别是对于有系统性血栓溶解禁忌的患者.
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