早期肺動(dòng)脈切開取栓術(shù)在治療急性肺動(dòng)脈栓塞患者中的臨床研究摘要：目的：探討早期肺動(dòng)脈切開取栓術(shù)在治療急性肺動(dòng)脈栓塞患者中的療效和安全性。方法：選擇2016年1月至2019年10月在我院急診科收治的121例急性肺動(dòng)脈栓塞患者，分別隨機(jī)分為研究組和對(duì)照組。研究組采用早期肺動(dòng)脈切開取栓術(shù)治療，對(duì)照組采用常規(guī)抗凝治療。比較兩組治療前后患者心電圖、CT影像、肺血流動(dòng)力學(xué)參數(shù)、各項(xiàng)生化指標(biāo)及臨床癥狀、并發(fā)癥等變化。結(jié)果：研究組患者治療后心電圖改善程度、動(dòng)脈血氧分壓提高程度、動(dòng)脈血二氧化碳分壓下降程度等各項(xiàng)指標(biāo)均顯著優(yōu)于對(duì)照組(P<0.05)；各項(xiàng)生化指標(biāo)如D-二聚體、凝血酶原時(shí)間、纖維蛋白原等均比對(duì)照組明顯下降(P<0.05)；且研究組無取栓相關(guān)并發(fā)癥。結(jié)論：在治療急性肺動(dòng)脈栓塞患者中，早期肺動(dòng)脈切開取栓術(shù)是一種安全有效的治療方法。

關(guān)鍵詞：早期肺動(dòng)脈切開取栓術(shù)，急性肺動(dòng)脈栓塞，臨床研究，安全性，療效

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