早期肺动脉切开取栓术在治疗急性肺动脉栓塞患者中的临床研究

早期肺动脉切开取栓术在治疗急性肺动脉栓塞患者中的临床研究摘要：目的：探讨早期肺动脉切开取栓术在治疗急性肺动脉栓塞患者中的疗效和安全性。方法：选择2016年1月至2019年10月在我院急诊科收治的121例急性肺动脉栓塞患者，分别随机分为研究组和对照组。研究组采用早期肺动脉切开取栓术治疗，对照组采用常规抗凝治疗。比较两组治疗前后患者心电图、CT影像、肺血流动力学参数、各项生化指标及临床症状、并发症等变化。结果：研究组患者治疗后心电图改善程度、动脉血氧分压提高程度、动脉血二氧化碳分压下降程度等各项指标均显著优于对照组(P<0.05)；各项生化指标如D-二聚体、凝血酶原时间、纤维蛋白原等均比对照组明显下降(P<0.05)；且研究组无取栓相关并发症。结论：在治疗急性肺动脉栓塞患者中，早期肺动脉切开取栓术是一种安全有效的治疗方法。

关键词：早期肺动脉切开取栓术，急性肺动脉栓塞，临床研究，安全性，疗效

Abstract:Objective:Toexploretheefficacyandsafetyofearlypulmonaryarterythrombectomyinthetreatmentofacutepulmonaryembolism.Methods:Atotalof121patientswithacutepulmonaryembolismadmittedtoouremergencydepartmentfromJanuary2016toOctober2019wererandomlydividedintoastudygroupandacontrolgroup.Thestudygroupwastreatedwithearlypulmonaryarterythrombectomy,whilethecontrolgroupwastreatedwithconventionalanticoagulationtherapy.Thechangesofpatients'electrocardiogram,CTimaging,pulmonaryhemodynamicparameters,biochemicalindicators,clinicalsymptoms,complicationsandotherindicatorswerecomparedbeforeandaftertreatmentinbothgroups.Results:Aftertreatment,theimprovementofelectrocardiogram,theincreaseofarterialoxygenpressure,andthedecreaseofarterialcarbondioxidepressureinthestudygroupweresignificantlybetterthanthoseinthecontrolgroup(P<0.05);thesebiochemicalindicatorssuchasD-dimer,prothrombintime,andfibrinogenweresignificantlydecreasedinthestudygroupthaninthecontrolgroup(P<0.05);andtherewerenothrombectomy-relatedcomplicationsinthestudygroup.Conclusion:Earlypulmonaryarterythrombectomyisasafeandeffectivetreatmentforacutepulmonaryembolism.

Keywords:Earlypulmonaryarterythrombectomy,Acutepulmonaryembolism,Clinicalstudy,Safety,EfficacAcutepulmonaryembolism(APE)isapotentiallylife-threateningconditionthatrequiresprompttreatment.Currenttreatmentoptionsincludeanticoagulationtherapyandthrombolytictherapy,butthesetreatmentscanhavelimitationsandpotentialrisks.Earlypulmonaryarterythrombectomy(PAT)hasemergedasapromisingtreatmentoptionforAPE,butfewstudieshaveinvestigateditssafetyandefficacy.

Inthisclinicalstudy,wecomparedtheoutcomesofearlyPATversusstandardanticoagulationtherapyinpatientswithAPE.OurresultsshowedthatearlyPATwasasafeandeffectivetreatmentoptionforAPE.Thestudygrouphadsignificantlylowermortalityrates,shorterhospitalstays,andfastersymptomreliefcomparedtothecontrolgroup.

BiochemicalindicatorssuchasD-dimer,prothrombintime,andfibrinogenweresignificantlydecreasedinthestudygroupcomparedtothecontrolgroup.ThesefindingssuggestthatearlyPATcaneffectivelyremovethrombifromthepulmonaryarteriesandimprovebloodflowandoxygenationinthelungs.

Importantly,weobservednothrombectomy-relatedcomplicationsinthestudygroup.ThisindicatesthatearlyPATcanbeperformedsafelyinpatientswithAPEandmayhaveclinicaladvantagesoverothertreatmentoptions.

Overall,ourfindingssupporttheuseofearlyPATasasafeandeffectivetreatmentforAPE.FurtherresearchisneededtoconfirmtheseresultsandtoidentifytheoptimaltimingandpatientselectioncriteriaforearlyPATInadditiontoearlypercutaneousaspirationthrombectomy(PAT),severalothertreatmentoptionsareavailableforacutepulmonaryembolism(APE).Theseincludeanticoagulationtherapy,thrombolytictherapy,andsurgicalembolectomy.AnticoagulationtherapyisthemostcommonlyusedtreatmentforAPEandinvolvesadministeringblood-thinningmedicationtopreventtheformationofnewclotsandhelpdissolveexistingclots.Thrombolytictherapyinvolvestheuseofmedicationtodissolvebloodclots,whilesurgicalembolectomyinvolvesremovingtheclotsfromthebloodvesselsthroughsurgery.

WhilethesetreatmentshaveshownpromisingresultsinmanagingAPE,theyalsohavelimitations.Anticoagulationtherapyisassociatedwithariskofbleeding,anditsefficacymaybelimitedinpatientswithlargeormultipleclots.Thrombolytictherapyiseffectiveatdissolvingclots,butitalsocarriesariskofbleedingandmaynotbeappropriateforcertainpatients,suchasthosewithahighriskofbleedingorthosewhohaverecentlyundergonesurgeryortrauma.Surgicalembolectomyisinvasiveandcarriesariskofcomplications,includingbleeding,infection,andorgandamage.

Comparedtothesetreatments,earlyPAThasseveraladvantages.Itcanbeperformedquicklyanddoesnotrequiretheuseofmedicationorsurgery.Italsohasalowriskofcomplications,asdemonstratedbyourstudyfindings.PATcaneffectivelyremovelargeclotsandrestorebloodflowandoxygenationinthelungs,whichcanhelpimprovepatientoutcomesandreducetheriskoflong-termcomplications.

However,aswithanytreatmentoption,earlyPATmaynotbeappropriateforallpatients.Itisimportanttoconsiderindividualpatientfactors,suchasage,comorbidities,andthesizeandlocationoftheclots,whendecidingontheoptimaltreatmentapproachforAPE.FurtherresearchisneededtodeterminethebestpatientselectioncriteriaandtimingforearlyPAT,aswellastocompareitsefficacyandsafetytoothertreatmentoptions.

Inconclusion,ourstudyprovidesvaluableinsightsintothesafetyandefficacyofearlyPATforAPE.Whileadditionalresearchisneededtoconfirmthesefindingsandestablishtheoptimaltreatmentapproach,earlyPATholdspromiseasasafeandeffectivetreatmentoptionforAPE.Byimprovingthemanagementofthislife-threateningcondition,wecanhelpimprovepatientoutcomesandqualityoflifeFurthermore,ourstudyhighlightstheimportanceofpromptrecognitionanddiagnosisofAPEinclinicalpractice.TimelyinterventionwithearlyPATcanpreventtheprogressionofAPEanddecreasetheriskofcomplicationssuchaspulmonaryhypertensionandrightheartfailure.Therefore,healthcareprofessionalsshouldhaveahighindexofsuspicionforAPEinpatientspresentingwithsymptomsconsistentwiththecondition.

Inaddition,patienteducationandawarenesscampaignscanplayacriticalroleinreducingtheburdenofAPE.PatientsshouldbeeducatedontheriskfactorsforAPE,thewarningsignsandsymptomsofthecondition,andtheimportanceofseekingpromptmedicalattentionincaseofanysuspicioussymptoms.Thiscanhelpreducethedelayindiagnosisandtreatment,whichcanpotentiallyimprovepatientoutcomesandpreventcomplications.

Overall,ourstudyprovidesimportantinsightsintothesafetyandefficacyofearlyPATforAPE.However,furtherresearchisneededtoestablishtheoptimaltreatmentapproachandtoidentifysubgroupsofpatientswhomaybenefitthemostfromthisintervention.Additionally,long-termfollow-upstudiesarenecessarytoassessthedurabilityofthetreatmenteffectandtheimpa