中国中西医结合急救杂志2025，Vol.32Issue(5)：556-560,5.DOI:10.3969/j.issn.1008-9691.2025.05.008
静脉-动脉体外膜肺氧合辅助介入血栓抽吸在急性高危肺栓塞患者治疗中的作用
Effect of veno-arterial extracorporeal membrane oxygenation-assisted interventional thromboaspiration in the treatment of patients with acute high-risk pulmonary embolism
摘要
Abstract
Objective To investigate the clinical efficacy of interventional pulmonary thromboaspiration in patients with high-risk acute pulmonary embolism supported by veno-arterial extracorporeal membrane oxygenation(VA-ECMO).Methods Five patients with high-risk pulmonary embolism admitted to the department of critical care medicine of Henan Provincial People's Hospital from January 2021 to December 2023 were enrolled.All 5 patients underwent interventional pulmonary artery thromboaspiration under VA-ECMO support,and the general information of the patients were observed[including gender,age,and high-risk factors for thrombosis(hypertension,diabetes,malignant tumors,smoking history,recent trauma,recent surgery or invasive surgery,fracture immobilization)],laboratory test results[including N-terminal pro-brain natriuretic peptide(NT-proBNP),troponin I(TnI),D-dimer],ultrasound and imaging examinations[including point-of-care ultrasound,CT pulmonary arteriography(CTPA)],clinical data[including simplified pulmonary embolism severity index(sPESI),initial treatment measures,right ventricle/left ventricle(RV/LV)diameter ratio under beside ultrasound before and after interventional embolectomy,oxygenation index(PaO2/FiO2),total time on ECMO,complications of interventional thrombectomy,ECMO complications,ECMO evacuation and 30-day death status].Results The age of 5 patients was 66-86 years old,of which 4 were female.A total of 4 cases had pulmonary embolism after surgery,3 cases were after surgery for digestive system tumors,1 case was after surgery for right femoral neck fracture,and 1 case was not screened for common risk factors for thrombosis.Pulmonary embolism was diagnosed in 4 patients by CTPA,and 1 patient showed right ventricular dilatation and obvious left ventricular compression(D-shaped sign)in 1 patient,of which 1 case saw thrombosis in the right ventricle.All 5 patients were confirmed by pulmonary arteriography to have filling defects of the main trunk of the pulmonary artery and/or the left and right pulmonary arteries and their branches.A total of 3 patients suffered cardiac arrest during the course of their illness,and 2 of them urgently initiated extracorporeal cardiopulmonary resuscitation(ECPR).After catheter interventional thromboaspiration treatment,the RV/LV diameter ratio decreased significantly,spontaneous circulation improved and oxygenation increased.ECMO duration ranged from 54.0 to 152.0 hours,and all patients were successfully weaned from ECMO without serious intervention or ECMO-related complications.One patient died of severe sepsis,while 1 patients died for 30 days.Conclusions For patients with high-risk acute pulmonary embolism who received VA-ECMO support,the clinical efficacy of interventional pulmonary artery thrombus aspiration therapy was excellent.When there are contraindications to thrombolysis or thrombolysis fails,especially in high-risk pulmonary embolism patients with cardiac arrest,VA-ECMO-assisted thromboaspiration may be a life-saving therapeutic option.关键词
体外膜肺氧合/高危肺栓塞/介入取栓治疗Key words
Extracorporeal membrane oxygenation/High-risk pulmonary embolism/Interventional thrombectomy引用本文复制引用
陈超,程文凤,陈银银,张克伟,邵换璋..静脉-动脉体外膜肺氧合辅助介入血栓抽吸在急性高危肺栓塞患者治疗中的作用[J].中国中西医结合急救杂志,2025,32(5):556-560,5.基金项目
河南省医学科技攻关计划联合共建项目(LHGJ20230065) Joint Construction Project of Henan Medical Science and Technology Research Plan(LHGJ20230065) （LHGJ20230065）
