| Objective To investigate the short-term clinical efficacy of catheter-directed thrombus fragmentation and aspiration combined with local urokinase perfusion in the treatment of acute pulmonary embolism(APE). Methods The clinical data of 48 patients with intermediate-high risk or higher acute pulmonary embolism admitted to the First Affiliated Hospital of Bengbu Medical University from January 2021 to April 2024 were retrospectively analyzed. According to the different treatment methods, the patients were divided into the catheterdirected thrombus fragmentation and aspiration group(n=28) and the control group(n=20). The differences in heart rate(HR), oxygen saturation(SpO2), arterial oxygen partial pressure(PaO2), and systolic blood pressure(SBP) between the two groups before treatment and 72 hours after treatment were compared; the occurrence of acute-phase complications was recorded; and the pulmonary artery pressure(PAP) and residual pulmonary artery thrombosis were evaluated before treatment and at 3, 6, and 12 months after treatment. Results Seventy-two hours after treatment, SpO2, PaO2, HR, and SBP were significantly improved in both groups compared with those before treatment(all P<0.05), and the improvement of these indicators in the catheter-directed thrombus fragmentation and aspiration group was more significant than that in the control group(all P<0.05). In the catheter-directed thrombus fragmentation and aspiration group, one patient died of cardiac arrest on the 4 th day after surgery, and no severe complications occurred in the remaining 27 patients. In the control group, one patient died of massive gastrointestinal bleeding on the 5 th day after treatment; three patients died of respiratory failure; one patient developed severe hypoxic-ischemic encephalopathy sequelae after cardiopulmonary resuscitation for cardiac arrest and died of severe pneumonia seven days later, with no severe complications in the remaining 15 patients. PAP in both groups was significantly lower 3, 6, and 12 months after treatment than that before treatment(all P<0.05), and PAP in the catheter-directed thrombus fragmentation and aspiration group was lower than that in the control group at all time points(all P<0.05). The residual thrombosis rate was 11.11% in the catheter-directed thrombus fragmentation and aspiration group three months after treatment, and the thrombosis completely disappeared in 6 months. In the control group, the residual thrombosis rate was 26.67% three months after treatment, only one patient had complete thrombosis resolution 6 months after surgery, and three patients were diagnosed with chronic thromboembolic pulmonary hypertension(CTEPH) in 12 months. Conclusion Catheter-directed thrombus fragmentation and aspiration combined with local urokinase perfusion is safe and effective in the treatment of intermediate-high risk and high-risk APE. It can effectively improve patients' right ventricular function, reduce pulmonary artery pressure, and minimize residual thrombosis. |
